Provider Demographics
NPI:1275533721
Name:JUDSON
Entity Type:Organization
Organization Name:JUDSON
Other - Org Name:JUDSON RETIREMENT COMMUNITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-791-2693
Mailing Address - Street 1:2181 AMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4645
Mailing Address - Country:US
Mailing Address - Phone:216-721-1234
Mailing Address - Fax:216-791-5595
Practice Address - Street 1:2181 AMBLESIDE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4645
Practice Address - Country:US
Practice Address - Phone:216-721-1234
Practice Address - Fax:216-791-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4783314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57821OtherQUALCHOICE
OH000000157017OtherANTHEM BLUE CROSS
OH0433883Medicaid
OH57821OtherQUALCHOICE