Provider Demographics
NPI:1861174989
Name:FARAH, HODAN ALI
Entity type:Individual
Prefix:
First Name:HODAN
Middle Name:ALI
Last Name:FARAH
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 1:5617 COUNTRIE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9068
Mailing Address - Country:US
Mailing Address - Phone:614-966-0390
Mailing Address - Fax:
Practice Address - Street 1:5617 COUNTRIE GLEN DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9068
Practice Address - Country:US
Practice Address - Phone:614-966-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No374U00000XNursing Service Related ProvidersHome Health Aide