Provider Demographics
NPI:1619583762
Name:TAWNEY, GROVER STEVEN
Entity type:Individual
Prefix:
First Name:GROVER
Middle Name:STEVEN
Last Name:TAWNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HIGH ST APT 863
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5409
Mailing Address - Country:US
Mailing Address - Phone:330-208-7066
Mailing Address - Fax:
Practice Address - Street 1:2200 HIGH ST APT 863
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5409
Practice Address - Country:US
Practice Address - Phone:330-208-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101630Medicaid