Provider Demographics
NPI:1700639119
Name:DYNISHA GRIMES LLC
Entity Type:Organization
Organization Name:DYNISHA GRIMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYNISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-355-1256
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No174200000XOther Service ProvidersMeals
No251V00000XAgenciesVoluntary or Charitable
No305S00000XManaged Care OrganizationsPoint of Service
No347C00000XTransportation ServicesPrivate Vehicle