MEDICARE: MRS. DEBRA ANN HODGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	1805541	OH

General Provider Information

NPI Number	:	1972106714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANN HODGE

Provider Business Mailing Address
First Line	:	3309 BERKELEY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2056
Country	:	US
Telephone Number	:	121-650-9516
Fax Number	:	216-932-5089

Provider Business Practice Location Address
First Line	:	3309 BERKELEY RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2056
Country	:	US
Telephone Number	:	216-509-5165
Fax Number	:	216-932-5089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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