Provider Demographics
NPI:1205648714
Name:GRIMES, CORI RAYANNE
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:RAYANNE
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 1:503 NORTH MAIN STREET
Mailing Address - Street 2:PO BOX: 845
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334
Mailing Address - Country:US
Mailing Address - Phone:614-980-6173
Mailing Address - Fax:
Practice Address - Street 1:414 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9690
Practice Address - Country:US
Practice Address - Phone:614-800-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant