Provider Demographics
NPI:1669260444
Name:GROSS, DANELLIA DEBORAH
Entity type:Individual
Prefix:
First Name:DANELLIA
Middle Name:DEBORAH
Last Name:GROSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 TOWNSHIP ROAD 108
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43324-9613
Mailing Address - Country:US
Mailing Address - Phone:704-941-5461
Mailing Address - Fax:
Practice Address - Street 1:2240 TOWNSHIP ROAD 108
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43324-9613
Practice Address - Country:US
Practice Address - Phone:704-941-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVM5790063747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant