Healthcare Provider Details

I. General information

NPI: 1023615895
Provider Name (Legal Business Name): MRS. ANDREA LYNN GROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 FLATFOOT RD
CABLE OH
43009-9741
US

IV. Provider business mailing address

4525 FLATFOOT RD
CABLE OH
43009-9741
US

V. Phone/Fax

Practice location:
  • Phone: 937-418-7164
  • Fax:
Mailing address:
  • Phone: 937-418-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: