Provider Demographics
NPI:1760157481
Name:GROVES, ANITA ELAINE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ELAINE
Last Name:GROVES
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 1:1 CONVENT AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2655
Mailing Address - Country:US
Mailing Address - Phone:313-424-3366
Mailing Address - Fax:
Practice Address - Street 1:19101 JEANETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7257
Practice Address - Country:US
Practice Address - Phone:313-424-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide