Provider Demographics
NPI:1396364212
Name:MINDFUL GROWTH FOUNDATION
Entity Type:Organization
Organization Name:MINDFUL GROWTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/MPH
Authorized Official - Phone:323-590-9813
Mailing Address - Street 1:3924 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1755
Mailing Address - Country:US
Mailing Address - Phone:323-998-0654
Mailing Address - Fax:323-967-7746
Practice Address - Street 1:3924 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1755
Practice Address - Country:US
Practice Address - Phone:323-998-0654
Practice Address - Fax:323-967-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness