Provider Demographics
NPI:1760235162
Name:GRIMES, DYNISHA
Entity Type:Individual
Prefix:
First Name:DYNISHA
Middle Name:
Last Name:GRIMES
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 1:6714 E PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6328
Mailing Address - Country:US
Mailing Address - Phone:216-355-1256
Mailing Address - Fax:
Practice Address - Street 1:6714 E PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6328
Practice Address - Country:US
Practice Address - Phone:216-355-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator