Provider Demographics
NPI:1992458418
Name:GROWTH HEALTH AND WELLNESS
Entity type:Organization
Organization Name:GROWTH HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-343-9468
Mailing Address - Street 1:5151 MONROE ST STE 231A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3462
Mailing Address - Country:US
Mailing Address - Phone:937-239-5873
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST STE 231A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3462
Practice Address - Country:US
Practice Address - Phone:937-239-5873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1134783442Medicaid