OrganizationActive
Growth Extended, Inc.
NPI 1710428628 · Psychiatric Residential Treatment Facility · Lake Balboa, CA
Provider details
- NPI number
- 1710428628
- Entity type
- Organization
- Primary specialty
- Psychiatric Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- John Lewis, Cfo(888) 948-9998
- License
- 190794AP (CA)
Specialties & taxonomies
Residential Treatment Facilities
Residential Treatment Facilities
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
15743 Covello St
Lake Balboa, CA 91406-3120
Phone: (888) 948-9998
Fax: (888) 751-6166
Street-level locationGet directions
Mailing address
60 N Lotus Ave
Pasadena, CA 91107-3811
Registry dates
- Enumerated
- 2017-03-10
- Last updated
- 2024-03-31
- Certified
- 2024-03-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.