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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY ROSS HODGSON MD (CEO)
(209) 206-1177
Entity
Organization

Contact information

Practice address
20100 QUARTZ MOUNTAIN ROAD NORTH, FIDDLETOWN, CA 95629
(209) 206-1177
Mailing address
PO BOX 353, FIDDLETOWN, CA 95629-0353
(209) 206-1177

Taxonomy

Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
261QP2300X
Primary Care Clinic/Center
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Enumeration date
05/11/2023
Last updated
05/11/2023
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