1972950053 NPI number — HUDSON INTEGRATIVE HEALTH HOME, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972950053 NPI number — HUDSON INTEGRATIVE HEALTH HOME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON INTEGRATIVE HEALTH HOME, LLC
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:
HUDSON INTEGRATIVE, LLC
Provider Other Organization Name Type Code:
3
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:
1972950053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 28TH ST
Provider Second Line Business Mailing Address:
S-100
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80303-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-442-6444
Provider Business Mailing Address Fax Number:
303-442-4505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 28TH ST
Provider Second Line Business Practice Location Address:
S-100
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80303-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-442-6444
Provider Business Practice Location Address Fax Number:
303-442-4505
Provider Enumeration Date:
05/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
303-442-6444

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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