Provider Demographics
NPI:1164000451
Name:GRIMM, RICKY ALLEN JR
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:ALLEN
Last Name:GRIMM
Suffix:JR
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 1:10841 MILLCREEK RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-8880
Mailing Address - Country:US
Mailing Address - Phone:937-638-2493
Mailing Address - Fax:
Practice Address - Street 1:10841 MILLCREEK RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8880
Practice Address - Country:US
Practice Address - Phone:937-638-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide