Provider Demographics
NPI:1043490824
Name:GROVES ACADEMY
Entity Type:Organization
Organization Name:GROVES ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:952-915-4257
Mailing Address - Street 1:3200 HIGHWAY 100 S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2175
Mailing Address - Country:US
Mailing Address - Phone:952-920-6377
Mailing Address - Fax:952-920-2068
Practice Address - Street 1:3200 HIGHWAY 100 S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2175
Practice Address - Country:US
Practice Address - Phone:952-920-6377
Practice Address - Fax:952-920-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1736103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty