Provider Demographics
NPI:1134975733
Name:RODGERS, CHANEL L
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:L
Last Name:RODGERS
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 1:6150 ENTERPRISE PKWY # 110
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2755
Mailing Address - Country:US
Mailing Address - Phone:216-703-0252
Mailing Address - Fax:
Practice Address - Street 1:6150 ENTERPRISE PKWY # 110
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2755
Practice Address - Country:US
Practice Address - Phone:216-703-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 251E00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health