Provider Demographics
NPI:1972106714
Name:HODGE, DEBRA ANN
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2056
Mailing Address - Country:US
Mailing Address - Phone:121-650-9516
Mailing Address - Fax:216-932-5089
Practice Address - Street 1:3309 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2056
Practice Address - Country:US
Practice Address - Phone:216-509-5165
Practice Address - Fax:216-932-5089
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18055413747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant