Provider Demographics
NPI:1841949328
Name:GROW HEALTHCARE GROUP OF NEW JERSEY PC
Entity type:Organization
Organization Name:GROW HEALTHCARE GROUP OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-851-1139
Mailing Address - Street 1:221 RIVER ST. FL 9
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5990
Mailing Address - Country:US
Mailing Address - Phone:201-439-8902
Mailing Address - Fax:
Practice Address - Street 1:221 RIVER ST. FL 9
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5990
Practice Address - Country:US
Practice Address - Phone:201-439-8902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health