Provider Demographics
NPI:1689302895
Name:POWER TO GROW LLC
Entity Type:Organization
Organization Name:POWER TO GROW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VASYLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-578-2161
Mailing Address - Street 1:279 CREST ST
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1417
Mailing Address - Country:US
Mailing Address - Phone:860-306-0794
Mailing Address - Fax:
Practice Address - Street 1:279 CREST ST
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1417
Practice Address - Country:US
Practice Address - Phone:860-306-0794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty