Provider Demographics
NPI:1356056964
Name:GROWTH SERVICES LLC
Entity type:Organization
Organization Name:GROWTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-562-3787
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE 325
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2874
Mailing Address - Country:US
Mailing Address - Phone:612-562-3787
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE 325
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2874
Practice Address - Country:US
Practice Address - Phone:612-562-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM640933000OtherUMPI