Healthcare Provider Details

I. General information

NPI: 1225943335
Provider Name (Legal Business Name): CARL J GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1994 12TH ST SW
AKRON OH
44314-3076
US

IV. Provider business mailing address

1994 12TH ST SW
AKRON OH
44314-3076
US

V. Phone/Fax

Practice location:
  • Phone: 330-510-8928
  • Fax:
Mailing address:
  • Phone: 330-510-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number03-8635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: