Provider Demographics
NPI:1619632502
Name:GROVER, TIWANNA CHANTRELL
Entity Type:Individual
Prefix:MS
First Name:TIWANNA
Middle Name:CHANTRELL
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONSUMER DIRECT CARE NETWORK 700
Mailing Address - Street 2:2611 SOUTH CLARK STREET
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202
Mailing Address - Country:US
Mailing Address - Phone:844-381-4432
Mailing Address - Fax:
Practice Address - Street 1:2611 SOUTH CAPITOL STREET
Practice Address - Street 2:700
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-9027
Practice Address - Country:US
Practice Address - Phone:844-381-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2278H0200X
DC2278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health