| Growspace Mh | |
|
10364 1/2 Mitchell Street West Frankfort IL 62896 | |
| (618) 218-5852 | |
| Not Available |
| Full Name | Growspace Mh |
|---|---|
| Speciality | Social Worker |
| Location | 10364 1/2 Mitchell Street, West Frankfort, Illinois |
| Authorized Official Name and Position | Rachel Lynn Taylor (CEO MANAGER) |
| Authorized Official Contact | 6182185852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Growspace Mh 10364 1/2 Mitchell Street West Frankfort IL 62896 Ph: (618) 218-5852 | Growspace Mh 10364 1/2 Mitchell Street West Frankfort IL 62896 Ph: (618) 218-5852 |
| NPI Number | 1578367975 |
|---|---|
| Provider Enumeration Date | 04/03/2025 |
| Last Update Date | 04/07/2025 |
| Certification Date | 04/07/2025 |
| Medicare PECOS PAC ID | 6002325081 |
|---|---|
| Medicare Enrollment ID | O20250602001312 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578367975 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Rachel Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710578737 PECOS PAC ID: 2163967944 Enrollment ID: I20240717000432 |
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