Provider Demographics
NPI:1134734924
Name:GROWTH CASE MANANGEMENT LLC
Entity type:Organization
Organization Name:GROWTH CASE MANANGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-229-0570
Mailing Address - Street 1:29701 6 MILE RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-8604
Mailing Address - Country:US
Mailing Address - Phone:313-802-1787
Mailing Address - Fax:313-340-2668
Practice Address - Street 1:29701 6 MILE RD STE 150A
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-8604
Practice Address - Country:US
Practice Address - Phone:313-802-1787
Practice Address - Fax:313-340-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management