Healthcare Provider Details

I. General information

NPI: 1235401076
Provider Name (Legal Business Name): THE GROWTH CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 SPRING HILL DR SUITE J
SPRING HILL FL
34606-4543
US

IV. Provider business mailing address

5330 SPRING HILL DR SUITE J
SPRING HILL FL
34606-4543
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-5595
  • Fax:
Mailing address:
  • Phone: 813-994-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberPY6278
License Number StateFL

VIII. Authorized Official

Name: MR. SAMUEL ANTHONY DEVOLA
Title or Position: BILLING MANAGER
Credential:
Phone: 813-994-5595