Provider Demographics
NPI:1477980340
Name:GROWING ROOTS
Entity Type:Organization
Organization Name:GROWING ROOTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:PAULA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-850-8281
Mailing Address - Street 1:2921 E 17TH ST
Mailing Address - Street 2:BLDG D, SUITE 4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1509
Mailing Address - Country:US
Mailing Address - Phone:512-850-8281
Mailing Address - Fax:
Practice Address - Street 1:2921 E 17TH ST
Practice Address - Street 2:BLDG D, SUITE 4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1509
Practice Address - Country:US
Practice Address - Phone:512-850-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management