Provider Demographics
NPI:1740537216
Name:HODGE, BERNADETTE CARROLL
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:CARROLL
Last Name:HODGE
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 1:5475 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3563
Mailing Address - Country:US
Mailing Address - Phone:216-254-7746
Mailing Address - Fax:216-518-9343
Practice Address - Street 1:5475 GRASMERE AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3563
Practice Address - Country:US
Practice Address - Phone:216-254-7746
Practice Address - Fax:216-518-9343
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP21230343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)