| Community Growth Center Inc. | |
|
4515 Nesconset Hwy Port Jefferson Station NY 11776-2600 | |
| (631) 240-3471 | |
| Not Available |
| Full Name | Community Growth Center Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4515 Nesconset Hwy, Port Jefferson Station, New York |
| Authorized Official Name and Position | Michael Hoffner (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5163066679 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Growth Center Inc. 4515 Nesconset Hwy Port Jefferson Station NY 11776-2600 Ph: (631) 240-3471 | Community Growth Center Inc. 4515 Nesconset Hwy Port Jefferson Station NY 11776-2600 Ph: (631) 240-3471 |
| NPI Number | 1255903324 |
|---|---|
| Provider Enumeration Date | 07/16/2021 |
| Last Update Date | 07/16/2021 |
| Certification Date | 07/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255903324 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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