Provider Demographics
NPI:1497178768
Name:INDIVIDUALS OF GROWTH
Entity Type:Organization
Organization Name:INDIVIDUALS OF GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-886-8844
Mailing Address - Street 1:1495 MORSE RD
Mailing Address - Street 2:B-9
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6478
Mailing Address - Country:US
Mailing Address - Phone:614-263-6063
Mailing Address - Fax:614-236-6059
Practice Address - Street 1:1495 MORSE RD
Practice Address - Street 2:B-9
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6478
Practice Address - Country:US
Practice Address - Phone:614-263-6063
Practice Address - Fax:614-236-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health