Healthcare Provider Details

I. General information

NPI: 1427841196
Provider Name (Legal Business Name): CYNTHIA GRANT CEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANISHA BROWN CEO

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 OLD BEULAH RD
SELMA NC
27576-8671
US

IV. Provider business mailing address

5275 OLD BEULAH RD
SELMA NC
27576-8671
US

V. Phone/Fax

Practice location:
  • Phone: 919-746-4155
  • Fax:
Mailing address:
  • Phone: 919-746-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: