Provider Demographics
NPI:1629951850
Name:GRANDERSON, LATOYA LASHAWN (OWNER)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:LASHAWN
Last Name:GRANDERSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W OGDEN AVE UNIT 2531
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-1222
Mailing Address - Country:US
Mailing Address - Phone:630-200-6257
Mailing Address - Fax:
Practice Address - Street 1:1750 W OGDEN AVE UNIT 2531
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60567-1222
Practice Address - Country:US
Practice Address - Phone:630-200-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL8500163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health