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General NPI Number Information
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NPI Number | 1003961384
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Entity Type | Organization
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Legal Business Name | GROWING ZONE THERAPEUTIC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 41 BAYBERRY DR
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City | SAINT JAMES
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State | NY
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Zip | 11780-2141
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Country | US
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Telephone | 631-242-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 41 BAYBERRY DRIVE
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City | ST JAMES
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State | NY
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Zip | 11780-2141
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Country | US
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Telephone | 631-242-0240
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANNA MARIA GAMBINO
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Credential | MS
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Telephone | 631-242-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 110743045
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 110743045
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License Number State | NY
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