Provider Demographics
NPI:1245587625
Name:KEIRRA GRILLS
Entity Type:Organization
Organization Name:KEIRRA GRILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:KEIRRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-466-1441
Mailing Address - Street 1:26670 LOGANBERRY DR APT A318
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-5103
Mailing Address - Country:US
Mailing Address - Phone:216-466-1441
Mailing Address - Fax:
Practice Address - Street 1:26670 LOGANBERRY DR APT A318
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-5103
Practice Address - Country:US
Practice Address - Phone:216-466-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-05
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144238313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility