Provider Demographics
NPI:1033815592
Name:GROVE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:GROVE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:UPTHEGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:920-381-9859
Mailing Address - Street 1:N590 RABBIT RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:WI
Mailing Address - Zip Code:54940-9503
Mailing Address - Country:US
Mailing Address - Phone:920-381-9859
Mailing Address - Fax:930-325-0022
Practice Address - Street 1:N590 RABBIT RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:WI
Practice Address - Zip Code:54940-9503
Practice Address - Country:US
Practice Address - Phone:920-381-9859
Practice Address - Fax:930-325-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty