Provider Demographics
NPI:1780014506
Name:GROWTH R US
Entity Type:Organization
Organization Name:GROWTH R US
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-539-2135
Mailing Address - Street 1:2015 BRUCKNER BLVD
Mailing Address - Street 2:APT.5C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6510
Mailing Address - Country:US
Mailing Address - Phone:917-539-2135
Mailing Address - Fax:
Practice Address - Street 1:2015 BRUCKNER BLVD
Practice Address - Street 2:APT.5C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6510
Practice Address - Country:US
Practice Address - Phone:917-539-2135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency