Provider Demographics
NPI:1558967224
Name:DARRELL A AND TERESA A GRANT
Entity Type:Organization
Organization Name:DARRELL A AND TERESA A GRANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-909-9962
Mailing Address - Street 1:87 ASHTON VILLAGE DR.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082
Mailing Address - Country:US
Mailing Address - Phone:866-909-9962
Mailing Address - Fax:
Practice Address - Street 1:87 ASHTON VILLAGE DR.
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:866-909-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies