Healthcare Provider Details

I. General information

NPI: 1205648714
Provider Name (Legal Business Name): CORI RAYANNE GRIMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N DETROIT ST
WEST LIBERTY OH
43357-9690
US

IV. Provider business mailing address

503 NORTH MAIN STREET PO BOX: 845
JACKSON CENTER OH
45334
US

V. Phone/Fax

Practice location:
  • Phone: 614-800-3310
  • Fax:
Mailing address:
  • Phone: 614-980-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: