Healthcare Provider Details

I. General information

NPI: 1790674497
Provider Name (Legal Business Name): TERESA GRIMMETT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 80 501 SANDLICK BR RD
BRUNO WV
25611
US

IV. Provider business mailing address

PO BOX 277
BRUNO WV
25611-0277
US

V. Phone/Fax

Practice location:
  • Phone: 304-688-3192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: