Healthcare Provider Details

I. General information

NPI: 1174863732
Provider Name (Legal Business Name): THE CENTER FOR GROWTH AND INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E EMPIRE AVE
BENTON HARBOR MI
49022-2020
US

IV. Provider business mailing address

1440 E EMPIRE AVE
BENTON HARBOR MI
49022-2020
US

V. Phone/Fax

Practice location:
  • Phone: 269-487-9820
  • Fax:
Mailing address:
  • Phone: 269-487-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: TAMI GOULD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 269-487-9827