Provider Demographics
NPI:1952479552
Name:GROWING HOME SE
Entity Type:Organization
Organization Name:GROWING HOME SE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:803-791-5513
Mailing Address - Street 1:440 KNOX ABBOTT DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4353
Mailing Address - Country:US
Mailing Address - Phone:803-791-5513
Mailing Address - Fax:803-739-0301
Practice Address - Street 1:440 KNOX ABBOTT DR
Practice Address - Street 2:SUITE 370
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-4353
Practice Address - Country:US
Practice Address - Phone:803-791-5513
Practice Address - Fax:803-739-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSR-0008300001-CPA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCBT004Medicaid
SC886MXHMedicaid