Provider Demographics
NPI:1558056911
Name:GROW WITH ME- CRECIENDO JUNTOS
Entity Type:Organization
Organization Name:GROW WITH ME- CRECIENDO JUNTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-598-7175
Mailing Address - Street 1:720 S FRONTAGE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5626
Mailing Address - Country:US
Mailing Address - Phone:805-242-6522
Mailing Address - Fax:805-540-5890
Practice Address - Street 1:720 S FRONTAGE RD STE 103
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-5626
Practice Address - Country:US
Practice Address - Phone:805-242-6522
Practice Address - Fax:805-540-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty