Provider Demographics
NPI:1487092318
Name:GRENNON, WILLIAM (HHA, CNA, PCA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GRENNON
Suffix:
Gender:M
Credentials:HHA, CNA, PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01931-0315
Mailing Address - Country:US
Mailing Address - Phone:978-412-5440
Mailing Address - Fax:
Practice Address - Street 1:424 HEIGHTS AT CAPE ANN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5341
Practice Address - Country:US
Practice Address - Phone:978-412-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide