Provider Demographics
NPI:1124833025
Name:GROWCOCK, MICHAEL DEAN
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:GROWCOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 CORNHUSKER HWY STE A10
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1592
Mailing Address - Country:US
Mailing Address - Phone:402-202-8087
Mailing Address - Fax:
Practice Address - Street 1:7010 GARLAND ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1444
Practice Address - Country:US
Practice Address - Phone:402-617-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home