Provider Demographics
NPI:1417639568
Name:GRANT, LUCRETIA (HOME CARE AGENCY)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:HOME CARE AGENCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3937
Mailing Address - Country:US
Mailing Address - Phone:860-794-2236
Mailing Address - Fax:
Practice Address - Street 1:80 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3937
Practice Address - Country:US
Practice Address - Phone:860-794-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001995251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health