Individual
MS. LYDIA HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CEO/PRESIDENT
Contact information
Practice address
8245 CORDOVA RD STE 1018245, CORDOVA, TN 38016-2086
(190) 138-4139
(901) 384-1395
Mailing address
8245 CORDOVA RD STE 101, CORDOVA, TN 38016-2086
(901) 384-1394
(901) 384-1395
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
L000000012725
TN
253Z00000X
In Home Supportive Care Agency
L000000013596
TN
253Z00000X
In Home Supportive Care Agency
Primary
L000000021903
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G0092
—
TN
Enumeration date
10/15/2015
Last updated
11/06/2023
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