Provider Demographics
NPI:1972264737
Name:WAY TO GROW LEARNING CENTER
Entity type:Organization
Organization Name:WAY TO GROW LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:208-340-7855
Mailing Address - Street 1:4569 WINDCREST DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4569 WINDCREST DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9421
Practice Address - Country:US
Practice Address - Phone:208-340-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVANT BEHAVIORAL HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities