Healthcare Provider Details

I. General information

NPI: 1427967637
Provider Name (Legal Business Name): JANAE GROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CENTER ST
CLAY WV
25043-7046
US

IV. Provider business mailing address

1038 CLINIC DR
IVYDALE WV
25113-8265
US

V. Phone/Fax

Practice location:
  • Phone: 304-587-7301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: