Provider Demographics
NPI:1255660429
Name:GROVE, MITCHEL WARREN
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:WARREN
Last Name:GROVE
Suffix:
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 1:5951 DARLINGTON NORTH RD
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9236
Mailing Address - Country:US
Mailing Address - Phone:419-871-2289
Mailing Address - Fax:
Practice Address - Street 1:5951 DARLINGTON NORTH RD
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9236
Practice Address - Country:US
Practice Address - Phone:567-686-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide