Healthcare Provider Details

I. General information

NPI: 1275764524
Provider Name (Legal Business Name): THE GROWTH AND RECOVERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1805
US

IV. Provider business mailing address

4079 OAK LN
LAFAYETTE HILL PA
19444-2612
US

V. Phone/Fax

Practice location:
  • Phone: 610-828-4298
  • Fax: 610-943-2322
Mailing address:
  • Phone: 610-828-4298
  • Fax: 610-943-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPS-003909-L
License Number StatePA

VIII. Authorized Official

Name: DR. ERIC EUGENE GRIFFIN-SHELLEY SR.
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 610-828-4298