Provider Demographics
NPI:1265271019
Name:GROW WITH SUPPORT HOME CARE
Entity type:Organization
Organization Name:GROW WITH SUPPORT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOENEICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-518-2708
Mailing Address - Street 1:1318 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1318 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4508
Practice Address - Country:US
Practice Address - Phone:513-518-2708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services