Organization
GROWING WINGS ADULT SERVICES LLC
Active
Other names
Growing Wings LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JODIE L DIETRY (OFFICE MANAGER)
(234) 334-7547
Entity
Organization
Contact information
Practice address
107 5TH ST SE STE 8, BARBERTON, OH 44203-4269
(234) 334-7547
Mailing address
107 5TH ST SE STE 8, BARBERTON, OH 44203-4269
(234) 334-7547
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000268699
OHIO SUPPLIER NUMBER
OH
05
—
0194567
—
OH
01
—
8501722
DEPARTMENT OF DEVELOPMENTAL DISABILITIES
OH
Enumeration date
10/29/2020
Last updated
10/29/2020
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