Provider Demographics
NPI:1265866875
Name:GROW AND GLOW INCORPORATED
Entity type:Organization
Organization Name:GROW AND GLOW INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-346-2459
Mailing Address - Street 1:218 SURF DR
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2472
Mailing Address - Country:US
Mailing Address - Phone:917-346-2459
Mailing Address - Fax:
Practice Address - Street 1:218 SURF DR
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2472
Practice Address - Country:US
Practice Address - Phone:917-346-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY47618252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency