Provider Demographics
NPI:1255903324
Name:COMMUNITY GROWTH CENTER INC.
Entity type:Organization
Organization Name:COMMUNITY GROWTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:516-306-6679
Mailing Address - Street 1:4515 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2600
Mailing Address - Country:US
Mailing Address - Phone:631-240-3471
Mailing Address - Fax:
Practice Address - Street 1:4515 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2600
Practice Address - Country:US
Practice Address - Phone:631-240-3471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)