Healthcare Provider Details

I. General information

NPI: 1326738857
Provider Name (Legal Business Name): GRIMM HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N MORTON AVE
MORTON IL
61550-1525
US

IV. Provider business mailing address

405 N MORTON AVE
MORTON IL
61550-1525
US

V. Phone/Fax

Practice location:
  • Phone: 309-263-4600
  • Fax: 309-263-4612
Mailing address:
  • Phone: 309-263-4600
  • Fax: 309-263-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BRETT GRIMM
Title or Position: OWNER
Credential:
Phone: 309-263-4600