=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992302640
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY HODGES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2020
-----------------------------------------------------
Last Update Date | 10/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8346 ARCANUM BEARSMILL RD
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45331-9282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-548-7070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2512 N LAKE RD
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47390-8368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-576-0285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------