1437211547 NPI number — HUDSON HEALTH CENTER

Table of content: (NPI 1437211547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437211547 NPI number — HUDSON HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437211547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3760 SHADOW GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91107-2239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-351-1034
Provider Business Mailing Address Fax Number:
626-351-8772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 S GRAND AVE
Provider Second Line Business Practice Location Address:
HUDSON HEALTH CENTER
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90007-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-744-3743
Provider Business Practice Location Address Fax Number:
213-744-6884
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDMORE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
213-744-3750

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X , with the licence number:  AO37871 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com