Organization
GROWTH EXTENDED, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LEWIS (CFO)
(888) 948-9998
Entity
Organization
Contact information
Practice address
15743 COVELLO ST, LAKE BALBOA, CA 91406-3120
(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
190794AP
CA
324500000X
Substance Abuse Rehabilitation Facility
190794AP
CA
Other
Enumeration date
03/10/2017
Last updated
03/31/2024
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