Healthcare Provider Details

I. General information

NPI: 1932596947
Provider Name (Legal Business Name): TOGETHER WE GROW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 THIBODO RD
VISTA CA
92081-7901
US

IV. Provider business mailing address

5055 VIEWRIDGE AVE
SAN DIEGO CA
92123-4313
US

V. Phone/Fax

Practice location:
  • Phone: 760-466-3560
  • Fax:
Mailing address:
  • Phone: 858-751-0209
  • Fax: 760-466-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number080000750
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number080000750
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number080000750
License Number StateCA

VIII. Authorized Official

Name: MS. TERRY JANE RACCIATO
Title or Position: PRESIDENT
Credential: RN, PHN
Phone: 760-466-3560