=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609610039
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALANIA GRAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2024
-----------------------------------------------------
Last Update Date | 06/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8767 S JAMAICA ST UNIT 4208
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-328-1444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8767 S JAMAICA ST UNIT 4208
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-328-1444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 00407270
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------