Provider Demographics
NPI:1952989923
Name:MINDFUL GROWTH FOUNDATION
Entity type:Organization
Organization Name:MINDFUL GROWTH FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/MPH
Authorized Official - Phone:323-590-9813
Mailing Address - Street 1:1811 W 41ST DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1517
Mailing Address - Country:US
Mailing Address - Phone:323-348-4615
Mailing Address - Fax:323-983-4212
Practice Address - Street 1:1811 W 41ST DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1517
Practice Address - Country:US
Practice Address - Phone:323-348-4615
Practice Address - Fax:323-983-4212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINDFUL GROWTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness