Healthcare Provider Details

I. General information

NPI: 1124981287
Provider Name (Legal Business Name): THE GROVE HEALING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6123 W NORTH AVE
MILWAUKEE WI
53213-1529
US

IV. Provider business mailing address

6123 W NORTH AVE
MILWAUKEE WI
53213-1529
US

V. Phone/Fax

Practice location:
  • Phone: 262-617-3908
  • Fax:
Mailing address:
  • Phone: 262-617-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA RINDAL
Title or Position: ACUPUNCTURIST
Credential: L.AC, MSAHM, BSN
Phone: 262-617-3908