Grimetime LLC

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

Legal business name

GRIMETIME LLC

Practice address

72 S Chestnut St
Wauregan, CT 06387-8708

Phone

(978) 332-3401

NPI assigned

Jul 22, 2024

Last updated

Jul 22, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mustapha Mboob, M

Title

Management

Phone

(978) 332-3401

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1386472520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35",
            "city": "WAUREGAN",
            "state": "CT",
            "postal_code": "063870035",
            "telephone_number": "860-897-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 S CHESTNUT ST",
            "city": "WAUREGAN",
            "state": "CT",
            "postal_code": "063878708",
            "telephone_number": "978-332-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRIMETIME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-21",
        "status": "A",
        "authorized_official_last_name": "MBOOB",
        "authorized_official_first_name": "MUSTAPHA",
        "authorized_official_title_or_position": "MANAGEMENT",
        "authorized_official_telephone_number": "978-332-3401",
        "authorized_official_credential": "M"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAM.GOV",
            "identifier": "N4AFC8K7B943",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Arlene Barone, MSW
• Elizabeth Zvingilas Brown, M.S., B.C.B.A.
• Jennifer Ann Chokas, LCSW
• Amber Cote, MA, LPC
• Jennifer Chokas, LCSW, LLC
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• Kyle J. Lepino, APRN
• Corinne Lewis, LCSW
• Wellness at the Farm, LLC

• Prevention Professional in Wauregan, CT
• Providers in Wauregan, CT by specialty
• Prevention Professional in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.