Healthcare Provider Details

I. General information

NPI: 1619760006
Provider Name (Legal Business Name): GROW HEALTHCARE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W FLAGLER ST STE 900
MIAMI FL
33130-1807
US

IV. Provider business mailing address

PO BOX 930
PORTSMOUTH NH
03802-0930
US

V. Phone/Fax

Practice location:
  • Phone: 201-293-7689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: RAFID FADUL
Title or Position: OWNER
Credential: MD
Phone: 201-293-7689