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General NPI Number Information
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NPI Number | 1053042150
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Entity Type | Organization
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Legal Business Name | FRESH WATER AT HUDSON ALF, LLC
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 14110 OLD DIXIE HWY
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City | HUDSON
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State | FL
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Zip | 34667-1362
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Country | US
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Telephone | 253-655-7192
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Fax |
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Provider Business Mailing Address
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Address Line | 11030 EVERGREEN WAY APT A302
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City | EVERETT
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State | WA
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Zip | 98204-4390
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Country | US
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Telephone | 253-655-7192
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONY TO
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Credential |
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Telephone | 727-379-1746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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