Provider Demographics
NPI:1053756353
Name:CENTER FOR GROWTH AND DEVELOPMENT, INC
Entity type:Organization
Organization Name:CENTER FOR GROWTH AND DEVELOPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:941-953-9559
Mailing Address - Street 1:3277 FRUITVILLE RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6410
Mailing Address - Country:US
Mailing Address - Phone:941-953-9559
Mailing Address - Fax:941-953-9552
Practice Address - Street 1:3277 FRUITVILLE RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6410
Practice Address - Country:US
Practice Address - Phone:941-953-9559
Practice Address - Fax:941-953-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT - 0000712261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center