Provider Demographics
NPI:1194606632
Name:GROWTHPATH LLC
Entity type:Organization
Organization Name:GROWTHPATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KHADAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-440-5588
Mailing Address - Street 1:515 15TH AVE S UNIT 222
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1428
Mailing Address - Country:US
Mailing Address - Phone:651-440-5588
Mailing Address - Fax:
Practice Address - Street 1:515 15TH AVE S UNIT 222
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1428
Practice Address - Country:US
Practice Address - Phone:651-440-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency