Provider Demographics
NPI:1710971809
Name:HUDSON MEMORIAL NURSING HOME
Entity Type:Organization
Organization Name:HUDSON MEMORIAL NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-863-8131
Mailing Address - Street 1:700 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4404
Mailing Address - Country:US
Mailing Address - Phone:870-863-8131
Mailing Address - Fax:870-863-8661
Practice Address - Street 1:700 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4404
Practice Address - Country:US
Practice Address - Phone:870-863-8131
Practice Address - Fax:870-863-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045214Medicare ID - Type Unspecified