Healthcare Provider Details

I. General information

NPI: 1366400103
Provider Name (Legal Business Name): HUDSON HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 W STREETSBORO ST
HUDSON OH
44236-2050
US

IV. Provider business mailing address

544 ENTERPRISE DR
LEWIS CENTER OH
43035-9704
US

V. Phone/Fax

Practice location:
  • Phone: 330-650-0436
  • Fax: 330-650-6096
Mailing address:
  • Phone: 937-825-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1751N
License Number StateOH

VIII. Authorized Official

Name: PAUL BERGSTEN
Title or Position: VP
Credential:
Phone: 937-825-6622