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NPI Code Detail

MEDICARE: CHARLETTA GRIMES

MEDICARE: CHARLETTA GRIMES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1033040522
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLETTA GRIMES
Provider Business Mailing Address
First Line : 16414 SOUTHPARK DR
Second Line :
City : WESTFIELD
State : IN
Zip : 46074-8396
Country : US
Telephone Number : 317-584-5166
Fax Number : 317-815-3861
Provider Business Practice Location Address
First Line : 1022 E 52ND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-1205
Country : US
Telephone Number : 317-584-5166
Fax Number : 317-815-3861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ CHARLETTA GRIMES ” Practice Location

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