Provider Demographics
NPI:1437764966
Name:STANLEY, JODY
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:STANLEY
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 1:5455 E GOSHEN RUN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERHILL
Mailing Address - State:OH
Mailing Address - Zip Code:43728-9017
Mailing Address - Country:US
Mailing Address - Phone:740-973-5147
Mailing Address - Fax:
Practice Address - Street 1:5455 E GOSHEN RUN RD
Practice Address - Street 2:
Practice Address - City:CHESTERHILL
Practice Address - State:OH
Practice Address - Zip Code:43728-9017
Practice Address - Country:US
Practice Address - Phone:740-973-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067962Medicaid
OH4504843OtherDODD