MEDICARE: KATHLEEN AND RANDOLPH HUDSON, LLC. DBA CHOICES IN LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124502091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN AND RANDOLPH HUDSON, LLC. DBA CHOICES IN LIVING

Provider Business Mailing Address
First Line	:	134 SW 57TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-7135
Country	:	US
Telephone Number	:	239-541-1211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3812 SKYLINE BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3323
Country	:	US
Telephone Number	:	239-540-6813
Fax Number	:	239-540-6813

Authorized Official
Title or Position	:	OWNER/TAX MATTERS PERSON
Name	:	RANDOLPH C HUDSON
Credential	:
Telephone Number	:	239-541-1211

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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