Provider Demographics
NPI:1235845793
Name:GROWING FOR LIFE LLC
Entity Type:Organization
Organization Name:GROWING FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANEZ-ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:515-661-1855
Mailing Address - Street 1:239 N 1630 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3384
Mailing Address - Country:US
Mailing Address - Phone:515-661-1855
Mailing Address - Fax:
Practice Address - Street 1:239 N 1630 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3384
Practice Address - Country:US
Practice Address - Phone:515-661-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health