Provider Demographics
NPI:1114138559
Name:MARKS GROWING CENTER, INC.
Entity Type:Organization
Organization Name:MARKS GROWING CENTER, INC.
Other - Org Name:MUSTARD SEED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:BISE
Authorized Official - Last Name:PRESIDENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-448-8278
Mailing Address - Street 1:317 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4513
Mailing Address - Country:US
Mailing Address - Phone:707-448-7558
Mailing Address - Fax:
Practice Address - Street 1:200 PEACH TREE AVE
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4443
Practice Address - Country:US
Practice Address - Phone:707-448-7558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60506FOtherPROVIDER NUMBER