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General NPI Number Information
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NPI Number | 1164146684
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Entity Type | Organization
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Legal Business Name | JEFFREY R HODGSON MD CORPORATION
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 20100 QUARTZ MOUTAIN ROAD NORTH
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City | FIDDLETOWN
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State | CA
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Zip | 95629
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Country | US
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Telephone | 312-305-9378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 353
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City | FIDDLETOWN
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State | CA
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Zip | 95629-0353
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Country | US
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Telephone | 312-305-9378
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY ROSS HODGSON
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Credential |
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Telephone | 312-305-9378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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