Provider Demographics
NPI:1073168902
Name:RAY-GROSS, CHANTALE (STNA)
Entity Type:Individual
Prefix:
First Name:CHANTALE
Middle Name:
Last Name:RAY-GROSS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E 233RD ST APT 76
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1189
Mailing Address - Country:US
Mailing Address - Phone:216-609-8637
Mailing Address - Fax:
Practice Address - Street 1:135 E 233RD ST APT 76
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1189
Practice Address - Country:US
Practice Address - Phone:216-609-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401507140413376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide