Healthcare Provider Details

I. General information

NPI: 1710971809
Provider Name (Legal Business Name): HUDSON MEMORIAL NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N COLLEGE AVE
EL DORADO AR
71730-4404
US

IV. Provider business mailing address

700 N COLLEGE AVE
EL DORADO AR
71730-4404
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-8131
  • Fax: 870-863-8661
Mailing address:
  • Phone: 870-863-8131
  • Fax: 870-863-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BILL YUTZY
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-863-8131