MEDICARE: HUDSON MEMORIAL NURSING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1710971809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON MEMORIAL NURSING HOME

Provider Business Mailing Address
First Line	:	700 N COLLEGE AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4404
Country	:	US
Telephone Number	:	870-863-8131
Fax Number	:	870-863-8661

Provider Business Practice Location Address
First Line	:	700 N COLLEGE AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4404
Country	:	US
Telephone Number	:	870-863-8131
Fax Number	:	870-863-8661

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BILL YUTZY
Credential	:
Telephone Number	:	870-863-8131

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	11/14/2007

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