=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497023154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD GROWTH HOMES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2011
-----------------------------------------------------
Last Update Date | 06/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3661 W OAKLAND PARK BLVD STE 305
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-793-2123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3661 W OAKLAND PARK BLVD STE 305
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-793-2123
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BILLING/UR
-----------------------------------------------------
Name | CHERISH LEMIEUX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-214-3194
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------