Provider Demographics
NPI:1538058151
Name:GRACE & GROWTH CENTER LLC
Entity type:Organization
Organization Name:GRACE & GROWTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEKO
Authorized Official - Middle Name:AMIR
Authorized Official - Last Name:SALIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-775-2334
Mailing Address - Street 1:808 BERRY ST APT 154
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:651-775-2334
Practice Address - Street 1:808 BERRY ST APT 154
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1390
Practice Address - Country:US
Practice Address - Phone:651-775-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center