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Organization
GROWTH EXTENDED
Active
Organization
GROWTH EXTENDED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN LEWIS (CFO)
(888) 948-9998
Entity
Organization
Contact information
Practice address
439 S SERRANO AVE, LOS ANGELES, CA 90020-3604
(888) 948-9998
(888) 751-6166
Mailing address
60 N LOTUS AVE, PASADENA, CA 91107-3811
(888) 948-9998
(888) 751-6166
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
198207997
CA
Other
Enumeration date
03/14/2013
Last updated
03/31/2024
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