Organization · NPI-2

Growth Extended

Psychiatric Residential Treatment Facility · Los Angeles, CA

NPI number1073854147

StatusActive

Last updated in NPPESMar 31, 2024

Details

NPI: 1073854147
Entity type: Organization (NPI-2)
Legal business name: Growth Extended
Organization subpart: No
Enumeration date: Mar 14, 2013
Certification date: Mar 31, 2024
Last updated: Mar 31, 2024

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
323P00000X	Psychiatric Residential Treatment Facility	–	–	Yes
3245S0500X	Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children	198207997	CA

Practice location

439 S Serrano Ave
Los Angeles, CA 90020-3604

Phone 888-948-9998 · Fax 888-751-6166

Mailing address

60 N Lotus Ave
Pasadena, CA 91107-3811

Phone 888-948-9998 · Fax 888-751-6166

Authorized official

John Lewis
Cfo
8889489998

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