MEDICARE: GROW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1013327816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW

Provider Business Mailing Address
First Line	:	1011 BAFFIN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1214
Country	:	US
Telephone Number	:	281-701-7669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 BAFFIN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1214
Country	:	US
Telephone Number	:	281-701-7669
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHERONIQUE THOMPSON
Credential	:
Telephone Number	:	281-701-7669

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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Directions to “GROW ” Practice Location

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