Individual ProviderTanika GrantCase Manager/Care CoordinatorOther Service ProvidersPractice Address5601 Domingo Rd NE, Albuquerque, NM 87108-1610(505) 268-5295PECOS EnrollmentBased on the most recent information from CMS, provider Tanika Grant does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1811673759Provider TypeIndividualFull NameGrant, TanikaGenderFemaleSole ProprietorNoEnumeration Date6/26/2023Last Updated6/26/2023Contact InformationPractice LocationPractice Address5601 Domingo Rd NE, Albuquerque, NM 87108-1610Phone(505) 268-5295FaxUnlisted FaxMailing LocationMailing Address5601 Domingo Rd NE, Albuquerque, NM 87108-1610Phone(505) 268-5295FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer