Provider Demographics
NPI:1932075629
Name:HASSAN, HODAN
Entity type:Individual
Prefix:
First Name:HODAN
Middle Name:
Last Name:HASSAN
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 1:12953 RIDGEMIST LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2118
Mailing Address - Country:US
Mailing Address - Phone:703-655-8720
Mailing Address - Fax:
Practice Address - Street 1:12953 RIDGEMIST LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2118
Practice Address - Country:US
Practice Address - Phone:571-278-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO0006082251E00000X, 385HR2060X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child