Jimmie C Grays

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

0014387 Issued in WI

Practice address

2903 15TH Ave
South Milwaukee, WI 53172-3031

Phone

(262) 497-8448

Fax

(262) 681-3118

NPI assigned

Jun 9, 2025

Last updated

Jun 9, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jimmie Grays Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1750276077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5221 GALLANT FOX LN",
            "city": "CALEDONIA",
            "state": "WI",
            "postal_code": "534026100",
            "telephone_number": "262-497-8448",
            "fax_number": "262-497-8448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2903 15TH AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531723031",
            "telephone_number": "262-497-8448",
            "fax_number": "262-681-3118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYS",
        "first_name": "JIMMIE",
        "middle_name": "C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WI",
            "license": "0014387",
            "primary": true
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "WI",
            "license": "0014387",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIMMIE",
            "last_name": "GRAYS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Nadine Haddad, M.D.

• Adult Care Home Facility in South Milwaukee, WI
• Providers in South Milwaukee, WI by specialty
• Adult Care Home Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.