Basic Information
| Provider Information | |||||||||
| NPI: | 1538578000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUDSON ELMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 563 W STREETSBORO ST | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442362050 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 563 WEST STREETSBORO STREET | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306500436 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2014 | ||||||||
| LastUpdateDate: | 08/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | CULP | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
| AuthorizedOfficialMiddleName: | MARY | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3306500436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 8770 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.