MEDICARE: BEL OAK OF HUDSON HOUSE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972315364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEL OAK OF HUDSON HOUSE, LLC

Provider Business Mailing Address
First Line	:	1700B S HUDSON AVE
Second Line	:
City	:	AURORA
State	:	MO
Zip	:	65605-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 FIR RD
Second Line	:
City	:	CARL JUNCTION
State	:	MO
Zip	:	64834-9222
Country	:	US
Telephone Number	:	417-782-5659
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	CRAIG WEINER
Credential	:
Telephone Number	:	417-678-2169

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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