Provider Demographics
NPI:1225890890
Name:HUDSON MANOR OPCO LLC
Entity Type:Organization
Organization Name:HUDSON MANOR OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PUNIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-280-2000
Mailing Address - Street 1:109 N BRUSH ST
Mailing Address - Street 2:STE 260
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:813-280-2000
Mailing Address - Fax:
Practice Address - Street 1:115 E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-280-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility