Provider Demographics
NPI:1619414752
Name:HUGO1CORP
Entity Type:Organization
Organization Name:HUGO1CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-784-3624
Mailing Address - Street 1:2515 E BUSINESS 98
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4702
Mailing Address - Country:US
Mailing Address - Phone:850-784-3624
Mailing Address - Fax:
Practice Address - Street 1:2515 E BUSINESS 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-4702
Practice Address - Country:US
Practice Address - Phone:850-784-3624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility