Provider Demographics
NPI:1518400811
Name:INTEGRITY - HUDSON MANOR, LLC
Entity Type:Organization
Organization Name:INTEGRITY - HUDSON MANOR, LLC
Other - Org Name:HUDSON MANOR , LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-438-1383
Mailing Address - Street 1:4900 KOGER BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2738
Mailing Address - Country:US
Mailing Address - Phone:336-438-1383
Mailing Address - Fax:336-438-1387
Practice Address - Street 1:13009 LAKE KARL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-2374
Practice Address - Country:US
Practice Address - Phone:727-856-5282
Practice Address - Fax:727-856-7163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRITY SENIOR PROPERTIES INVESTMENTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0245489Medicaid