Provider Demographics
NPI:1821619438
Name:GROW WELL ABA, LLC
Entity type:Organization
Organization Name:GROW WELL ABA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:DANEA
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:904-434-0785
Mailing Address - Street 1:3402 PARSON CT FL 32223
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7337
Mailing Address - Country:US
Mailing Address - Phone:904-323-1782
Mailing Address - Fax:
Practice Address - Street 1:3402 PARSON CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7337
Practice Address - Country:US
Practice Address - Phone:904-434-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245735711Medicaid
FL1821619438Medicaid