MEDICARE: ANGELA K GRILLIOTT

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
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1912724535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA K GRILLIOTT

Provider Business Mailing Address
First Line	:	202 N SULPHUR SPRINGS RD
Second Line	:
City	:	WEST ALEXANDRIA
State	:	OH
Zip	:	45381-9613
Country	:	US
Telephone Number	:	937-687-5237
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 N SULPHUR SPRINGS RD
Second Line	:
City	:	WEST ALEXANDRIA
State	:	OH
Zip	:	45381-9613
Country	:	US
Telephone Number	:	937-272-4102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2024
Last Update Date	:	09/24/2024

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Directions to “ ANGELA K GRILLIOTT ” Practice Location

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