Healthcare Provider Details

I. General information

NPI: 1124833025
Provider Name (Legal Business Name): MR. MICHAEL DEAN GROWCOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 GARLAND ST
LINCOLN NE
68505-1444
US

IV. Provider business mailing address

3243 CORNHUSKER HWY STE A10
LINCOLN NE
68504-1592
US

V. Phone/Fax

Practice location:
  • Phone: 402-617-8175
  • Fax:
Mailing address:
  • Phone: 402-202-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: