Provider Demographics
NPI:1568459840
Name:CHRISTIAN COMMUNITY HOME OF HUDSON, INC
Entity Type:Organization
Organization Name:CHRISTIAN COMMUNITY HOME OF HUDSON, INC
Other - Org Name:CHRISTIAN COMMUNITY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-381-4210
Mailing Address - Street 1:1320 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1861
Mailing Address - Country:US
Mailing Address - Phone:715-386-9303
Mailing Address - Fax:
Practice Address - Street 1:1320 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1861
Practice Address - Country:US
Practice Address - Phone:715-386-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN COMMUNITY HOMES AND SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
WI2664314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20108600Medicaid
WI525626Medicare ID - Type Unspecified