Provider Demographics
NPI:1083910277
Name:GROSS EMPOWERMENT FAMILY TRANSFORMATION SERVICES
Entity Type:Organization
Organization Name:GROSS EMPOWERMENT FAMILY TRANSFORMATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-831-2921
Mailing Address - Street 1:4025 HOLLY COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3210
Mailing Address - Country:US
Mailing Address - Phone:757-831-2921
Mailing Address - Fax:
Practice Address - Street 1:990 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1557
Practice Address - Country:US
Practice Address - Phone:757-831-2921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty