Provider Demographics
NPI:1386336832
Name:GROW AND THRIVE LLC
Entity type:Organization
Organization Name:GROW AND THRIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINOV
Authorized Official - Suffix:
Authorized Official - Credentials:MSSPED
Authorized Official - Phone:917-916-7267
Mailing Address - Street 1:5028 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1633
Mailing Address - Country:US
Mailing Address - Phone:917-916-7267
Mailing Address - Fax:
Practice Address - Street 1:5028 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1633
Practice Address - Country:US
Practice Address - Phone:917-916-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency