Healthcare Provider Details

I. General information

NPI: 1558014621
Provider Name (Legal Business Name): TAIKEISHA GRANDBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 HARVARD AVE
CLEVELAND OH
44105-5008
US

IV. Provider business mailing address

6929 HARVARD AVE
CLEVELAND OH
44105-5008
US

V. Phone/Fax

Practice location:
  • Phone: 440-674-7295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: