Provider Demographics
NPI:1598170680
Name:STUBBS, HANSEL
Entity Type:Individual
Prefix:
First Name:HANSEL
Middle Name:
Last Name:STUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MORAN AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2758
Mailing Address - Country:US
Mailing Address - Phone:419-539-6804
Mailing Address - Fax:
Practice Address - Street 1:1205 MORAN AVE APT 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2758
Practice Address - Country:US
Practice Address - Phone:419-539-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization