Healthcare Provider Details

I. General information

NPI: 1972106714
Provider Name (Legal Business Name): MRS. DEBRA ANN HODGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 BERKELEY RD
CLEVELAND HTS OH
44118-2056
US

IV. Provider business mailing address

3309 BERKELEY RD
CLEVELAND HTS OH
44118-2056
US

V. Phone/Fax

Practice location:
  • Phone: 216-509-5165
  • Fax: 216-932-5089
Mailing address:
  • Phone: 121-650-9516
  • Fax: 216-932-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1805541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: