1114337300 NPI number — GROWTH CLIMATE RELATIONSHIP EDUCATION CENTER, INC.

Table of content: (NPI 1114337300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114337300 NPI number — GROWTH CLIMATE RELATIONSHIP EDUCATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROWTH CLIMATE RELATIONSHIP EDUCATION CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GROWTH CLIMATE RELATIONSHIP EDUCATION & COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114337300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 NORTH 1330 WEST
Provider Second Line Business Mailing Address:
SUITE NO. A-1
Provider Business Mailing Address City Name:
OREM
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84057-4154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-691-1153
Provider Business Mailing Address Fax Number:
801-691-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 NORTH 1330 WEST
Provider Second Line Business Practice Location Address:
SUITE NO A-1
Provider Business Practice Location Address City Name:
OREM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84057-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-691-1153
Provider Business Practice Location Address Fax Number:
801-691-0421
Provider Enumeration Date:
04/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
PATEY
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
TREATMENT PROVIDER
Authorized Official Telephone Number:
801-623-3211

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6293883-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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