Provider Demographics
NPI:1588398366
Name:GRO COMMUNITY OHIO LLC
Entity type:Organization
Organization Name:GRO COMMUNITY OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-253-8385
Mailing Address - Street 1:259 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5014
Mailing Address - Country:US
Mailing Address - Phone:773-253-8385
Mailing Address - Fax:
Practice Address - Street 1:6809 MAIN ST # 1038
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3470
Practice Address - Country:US
Practice Address - Phone:773-253-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRO COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)