Provider Demographics
NPI:1144404542
Name:HUDSON'S FAMILY CARE HOME #2
Entity Type:Organization
Organization Name:HUDSON'S FAMILY CARE HOME #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-3710
Mailing Address - Street 1:4028 OLD NC HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-1920
Mailing Address - Country:US
Mailing Address - Phone:336-629-3710
Mailing Address - Fax:
Practice Address - Street 1:4028 OLD NC HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-1920
Practice Address - Country:US
Practice Address - Phone:336-629-3710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH076019261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803517Medicaid