Provider Demographics
NPI:1295848661
Name:GRIMLEY, FRED JOSEPH
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:JOSEPH
Last Name:GRIMLEY
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 1:230 HURON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3822
Mailing Address - Country:US
Mailing Address - Phone:810-966-4478
Mailing Address - Fax:810-985-9498
Practice Address - Street 1:230 HURON AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3822
Practice Address - Country:US
Practice Address - Phone:810-966-4478
Practice Address - Fax:810-985-9498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist