Provider Demographics
NPI:1275764524
Name:THE GROWTH AND RECOVERY CENTER INC.
Entity Type:Organization
Organization Name:THE GROWTH AND RECOVERY CENTER INC.
Other - Org Name:ERIC GRIFFIN-SHELLEY, PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GRIFFIN-SHELLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-828-4298
Mailing Address - Street 1:4079 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2612
Mailing Address - Country:US
Mailing Address - Phone:610-828-4298
Mailing Address - Fax:610-943-2322
Practice Address - Street 1:452 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1805
Practice Address - Country:US
Practice Address - Phone:610-828-4298
Practice Address - Fax:610-943-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003909-L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001400070Medicaid
PA154972Medicare PIN