=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760605323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GROWING CAPABILITIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14727 HILLSIDE RDG
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-665-9730
-----------------------------------------------------
Fax | 830-665-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 944 FM 2200 W
-----------------------------------------------------
City | DEVINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78016-4543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-665-9730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KENNETH CAPPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-665-9730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | 05859
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------