Provider Demographics
NPI:1003811084
Name:GROVE HOME MEDICAL, INC
Entity Type:Organization
Organization Name:GROVE HOME MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:V
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-343-6153
Mailing Address - Street 1:849 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2007
Mailing Address - Country:US
Mailing Address - Phone:330-343-6153
Mailing Address - Fax:330-364-1769
Practice Address - Street 1:849 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2007
Practice Address - Country:US
Practice Address - Phone:330-343-6153
Practice Address - Fax:330-364-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0508141Medicaid
OH000000155612OtherANTHEM #
OH=========OtherFED ID #
OH=========OtherFED ID #