Healthcare Provider Details

I. General information

NPI: 1275533721
Provider Name (Legal Business Name): JUDSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

IV. Provider business mailing address

2181 AMBLESIDE DR
CLEVELAND OH
44106-4645
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-1234
  • Fax: 216-791-5595
Mailing address:
  • Phone: 216-721-1234
  • Fax: 216-791-5595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4783
License Number StateOH

VIII. Authorized Official

Name: MRS. CYNTHIA DUNN
Title or Position: PRESIDENT
Credential:
Phone: 216-791-2693