Healthcare Provider Details

I. General information

NPI: 1396654000
Provider Name (Legal Business Name): RUSTY HUDSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8608 DEER BEND DR
HUBER HEIGHTS OH
45424-7067
US

IV. Provider business mailing address

8608 DEER BEND DR
HUBER HEIGHTS OH
45424-7067
US

V. Phone/Fax

Practice location:
  • Phone: 937-207-0390
  • Fax:
Mailing address:
  • Phone: 937-207-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: