Provider Demographics
NPI:1073739660
Name:GROWING EDGES LLC
Entity Type:Organization
Organization Name:GROWING EDGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARTOUT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-548-1444
Mailing Address - Street 1:19580 W INDIAN SCHOOL RD STE 105-134
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-2081
Mailing Address - Country:US
Mailing Address - Phone:602-548-1444
Mailing Address - Fax:602-548-1446
Practice Address - Street 1:18205 N 51ST AVE BLDG 2
Practice Address - Street 2:SUITE 115
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:602-548-1444
Practice Address - Fax:602-548-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z78040Medicare PIN