MEDICARE: MINDFUL GROWTH FOUNDATION

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1396364212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL GROWTH FOUNDATION

Provider Business Mailing Address
First Line	:	4900 ANGELES VISTA BLVD
Second Line	:
City	:	VIEW PARK
State	:	CA
Zip	:	90043-1737
Country	:	US
Telephone Number	:	323-998-0654
Fax Number	:	323-967-7746

Provider Business Practice Location Address
First Line	:	3924 W ADAMS BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1755
Country	:	US
Telephone Number	:	323-998-0654
Fax Number	:	323-967-7746

Authorized Official
Title or Position	:	CEO
Name	:	JASMINE MONIQUE SAMPSON
Credential	:	MSW/MPH
Telephone Number	:	323-590-9813

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	02/03/2026

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Directions to “MINDFUL GROWTH FOUNDATION ” Practice Location

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