Provider Demographics
NPI:1407420896
Name:CHASE, JODI (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27484 OREGON RD LOT 14
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6516
Mailing Address - Country:US
Mailing Address - Phone:419-494-5836
Mailing Address - Fax:
Practice Address - Street 1:27484 OREGON RD LOT 14
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-6516
Practice Address - Country:US
Practice Address - Phone:419-494-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0077119374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077119Medicaid