Provider Demographics
NPI:1710724497
Name:GROW WELLNESS FOUNDATION
Entity type:Organization
Organization Name:GROW WELLNESS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYUM GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-601-4120
Mailing Address - Street 1:200 E 5TH AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3173
Mailing Address - Country:US
Mailing Address - Phone:224-357-6296
Mailing Address - Fax:
Practice Address - Street 1:200 E 5TH AVE STE 108
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3173
Practice Address - Country:US
Practice Address - Phone:224-357-6296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)