Provider Demographics
NPI:1073968335
Name:GROVE, SAMUEL SR
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:GROVE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 CARPENTER RD
Mailing Address - Street 2:LOT 8
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9632
Mailing Address - Country:US
Mailing Address - Phone:734-217-6278
Mailing Address - Fax:
Practice Address - Street 1:3423 CARPENTER RD
Practice Address - Street 2:LOT 8
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9632
Practice Address - Country:US
Practice Address - Phone:734-217-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide