Provider Demographics
NPI:1538499686
Name:GROW MY LIFE, LLC
Entity Type:Organization
Organization Name:GROW MY LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:STROHM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:414-803-6372
Mailing Address - Street 1:2411 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-2951
Mailing Address - Country:US
Mailing Address - Phone:715-254-5844
Mailing Address - Fax:
Practice Address - Street 1:2411 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-2951
Practice Address - Country:US
Practice Address - Phone:715-254-5844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127906121251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health