Provider Demographics
NPI:1861669293
Name:GROOMING RESPONSIBLE OUTCOMES FOR WOMEN NOW
Entity Type:Organization
Organization Name:GROOMING RESPONSIBLE OUTCOMES FOR WOMEN NOW
Other - Org Name:THE G.R.O.W.N. PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATROYAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:804-321-1757
Mailing Address - Street 1:5554 PONY FARM DR APT A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2623
Mailing Address - Country:US
Mailing Address - Phone:804-321-1757
Mailing Address - Fax:
Practice Address - Street 1:5554 PONY FARM DR APT A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2623
Practice Address - Country:US
Practice Address - Phone:804-321-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VASS-305-06311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility