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General NPI Number Information
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NPI Number | 1760279343
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Entity Type | Organization
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Legal Business Name | OUTER GROWTH
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 13238 PRESTWICK DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-4014
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Country | US
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Telephone | 813-797-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 13238 PRESTWICK DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-4014
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Country | US
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Telephone | 813-797-8585
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEGOFF BARTHELEMY
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Credential |
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Telephone | 813-797-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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