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NPI Code Detail

MEDICARE: MINDFUL GROWTH FOUNDATION

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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1952989923
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL GROWTH FOUNDATION
Provider Business Mailing Address
First Line : 1811 W 41ST DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90062-1517
Country : US
Telephone Number : 323-348-4615
Fax Number : 323-983-4212
Provider Business Practice Location Address
First Line : 1811 W 41ST DR
Second Line :
City : LOS ANGELES
State : CA
Zip : 90062-1517
Country : US
Telephone Number : 323-348-4615
Fax Number : 323-983-4212
Authorized Official
Title or Position : DIRECTOR
Name : MISS JASMINE MONIQUE SAMPSON
Credential : MSW/MPH
Telephone Number : 323-590-9813
Provider Enumeration Date : 03/31/2021
Last Update Date : 04/14/2021

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Directions to “MINDFUL GROWTH FOUNDATION ” Practice Location

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