Healthcare Provider Details

I. General information

NPI: 1144475765
Provider Name (Legal Business Name): GRO FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W CAPITOL DR SUITE 200
MILWAUKEE WI
53216-2156
US

IV. Provider business mailing address

6400 W CAPITOL DR SUITE 200
MILWAUKEE WI
53216-2156
US

V. Phone/Fax

Practice location:
  • Phone: 414-445-1400
  • Fax: 414-395-4716
Mailing address:
  • Phone: 414-445-1400
  • Fax: 414-395-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2803
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number2803
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2803
License Number StateWI

VIII. Authorized Official

Name: MR. GREGORY RENARD OWENS
Title or Position: CEO
Credential:
Phone: 414-234-1263