Healthcare Provider Details

I. General information

NPI: 1669396339
Provider Name (Legal Business Name): GROW ROOTS & RISE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 COVEL ST
NORFOLK VA
23523-1704
US

IV. Provider business mailing address

1216 COVEL ST
NORFOLK VA
23523-1704
US

V. Phone/Fax

Practice location:
  • Phone: 757-582-5947
  • Fax:
Mailing address:
  • Phone: 757-582-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAMON PRIVOTT
Title or Position: CEO/PROGRAM MANAGER
Credential:
Phone: 757-582-5947