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General NPI Number Information
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NPI Number | 1275052029
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Entity Type | Organization
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Legal Business Name | DESTINED 2 GROW LLC.
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 RALSTON WAY
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-2901
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Country | US
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Telephone | 732-710-1804
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RALSTON WAY
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-2901
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Country | US
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Telephone | 732-710-1804
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATOR
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Name | ELSIE SHEGBONE
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Credential | MSED
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Telephone | 732-710-1804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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