Provider Demographics
NPI:1639511892
Name:FORT HUDSON CERTIFIED HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:FORT HUDSON CERTIFIED HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-747-2811
Mailing Address - Street 1:319 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1221
Mailing Address - Country:US
Mailing Address - Phone:518-747-2811
Mailing Address - Fax:518-747-2740
Practice Address - Street 1:319 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1221
Practice Address - Country:US
Practice Address - Phone:518-747-2811
Practice Address - Fax:518-747-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health