Provider Demographics
NPI:1184145195
Name:GRANT, AKASSI (PTC)
Entity type:Individual
Prefix:
First Name:AKASSI
Middle Name:
Last Name:GRANT
Suffix:
Gender:
Credentials:PTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1968
Mailing Address - Country:US
Mailing Address - Phone:872-210-0900
Mailing Address - Fax:
Practice Address - Street 1:119 S WESTERN AVE # 227
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4643
Practice Address - Country:US
Practice Address - Phone:872-210-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14011028183747P1801X
VA1401102818372500000X, 376K00000X
ILG653-0057-3964172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriver
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL80-0942613OtherTRANSPORTATION SERVICES