Provider Demographics
NPI:1235401076
Name:THE GROWTH CENTER,LLC
Entity Type:Organization
Organization Name:THE GROWTH CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DEVOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-994-5595
Mailing Address - Street 1:5330 SPRING HILL DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4543
Mailing Address - Country:US
Mailing Address - Phone:813-994-5595
Mailing Address - Fax:
Practice Address - Street 1:5330 SPRING HILL DR
Practice Address - Street 2:SUITE J
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4543
Practice Address - Country:US
Practice Address - Phone:813-994-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY62783245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1198Medicare UPIN