Provider Demographics
NPI:1023578705
Name:MINDFUL GROWTH FOUNDATION
Entity Type:Organization
Organization Name:MINDFUL GROWTH FOUNDATION
Other - Org Name:MINDFUL GROWTH FOUNDATION #2
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/MPH
Authorized Official - Phone:323-590-9813
Mailing Address - Street 1:3924 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1755
Mailing Address - Country:US
Mailing Address - Phone:323-998-0654
Mailing Address - Fax:323-967-7746
Practice Address - Street 1:1208 W 38TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-1106
Practice Address - Country:US
Practice Address - Phone:323-998-0655
Practice Address - Fax:323-967-7746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL GROWTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty