Provider Demographics
NPI:1659180305
Name:GROWTHWOOD LLC
Entity type:Organization
Organization Name:GROWTHWOOD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CORP DEV AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-352-9138
Mailing Address - Street 1:20500 BELSHAW AVE.
Mailing Address - Street 2:DPT#XLA1128
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 N GOLDEN CIRCLE DR STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3977
Practice Address - Country:US
Practice Address - Phone:800-778-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder