Healthcare Provider Details

I. General information

NPI: 1033073879
Provider Name (Legal Business Name): SHANTA RASHAWN GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 W BATH RD
CUYAHOGA FALLS OH
44223-3057
US

IV. Provider business mailing address

1220 W BATH RD
CUYAHOGA FALLS OH
44223-3057
US

V. Phone/Fax

Practice location:
  • Phone: 330-631-4773
  • Fax:
Mailing address:
  • Phone: 330-631-4773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: