Healthcare Provider Details

I. General information

NPI: 1891918918
Provider Name (Legal Business Name): DEBORAH I HODGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 OAK LANE
FAIRLEE VT
05045
US

IV. Provider business mailing address

69 OAK LANE
FAIRLEE VT
05045
US

V. Phone/Fax

Practice location:
  • Phone: 802-333-4829
  • Fax: 802-333-7091
Mailing address:
  • Phone: 802-333-4829
  • Fax: 802-333-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0195
License Number StateVT

VIII. Authorized Official

Name: DEBORAH I. HODGE
Title or Position: OWNER
Credential:
Phone: 802-333-4829