Basic Information
Provider Information | |||||||||
NPI: | 1053987487 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HUDSON HOME HEALTH CARE, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5959 SHALLOWFORD RD STE 443 | ||||||||
Address2: |   | ||||||||
City: | CHATTANOOGA | ||||||||
State: | TN | ||||||||
PostalCode: | 374212245 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4237562268 | ||||||||
FaxNumber: | 4233852142 | ||||||||
Practice Location | |||||||||
Address1: | 128 HALL ST STE F | ||||||||
Address2: |   | ||||||||
City: | CONCORD | ||||||||
State: | NH | ||||||||
PostalCode: | 033013451 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8006840270 | ||||||||
FaxNumber: | 6032249875 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2021 | ||||||||
LastUpdateDate: | 05/27/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MATUKEWICZ | ||||||||
AuthorizedOfficialFirstName: | JEFFREY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 4237562268 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/27/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171WH0202X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Contractor | Home Modifications |
No ID Information.