Provider Demographics
NPI:1669073383
Name:BUILD AND GROW DEVELOPMENT, LLC
Entity type:Organization
Organization Name:BUILD AND GROW DEVELOPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NECHAMA
Authorized Official - Middle Name:MALKA
Authorized Official - Last Name:KORETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:301-403-8823
Mailing Address - Street 1:1205 N BELGRADE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3023
Mailing Address - Country:US
Mailing Address - Phone:443-414-8220
Mailing Address - Fax:
Practice Address - Street 1:1205 N BELGRADE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3023
Practice Address - Country:US
Practice Address - Phone:443-414-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1316588965Medicaid