Provider Demographics
NPI:1134853419
Name:GRIMSLEY, SHANITTA KENYETTA (HOME CARE LLC)
Entity type:Individual
Prefix:
First Name:SHANITTA
Middle Name:KENYETTA
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:HOME CARE LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 ARIANA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1814
Mailing Address - Country:US
Mailing Address - Phone:813-638-3463
Mailing Address - Fax:
Practice Address - Street 1:1227 ARIANA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1814
Practice Address - Country:US
Practice Address - Phone:813-638-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker