Provider Demographics
NPI:1306611322
Name:GRILLO, BETH A (HHA, MSITPM, MHA)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:GRILLO
Suffix:
Gender:F
Credentials:HHA, MSITPM, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4501
Mailing Address - Country:US
Mailing Address - Phone:845-863-7003
Mailing Address - Fax:
Practice Address - Street 1:22 CHASE RD
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4501
Practice Address - Country:US
Practice Address - Phone:845-863-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20234111P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide