Healthcare Provider Details

I. General information

NPI: 1306632559
Provider Name (Legal Business Name): DOUG E GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 IRELAND AVE
CINCINNATI OH
45218-1136
US

IV. Provider business mailing address

14 IRELAND AVE
CINCINNATI OH
45218-1136
US

V. Phone/Fax

Practice location:
  • Phone: 513-720-8880
  • Fax:
Mailing address:
  • Phone: 513-720-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: