Provider Demographics
NPI:1851909964
Name:HUDUMA HOUSE, LLC
Entity Type:Organization
Organization Name:HUDUMA HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOSKEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-516-9785
Mailing Address - Street 1:6218 W RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043
Mailing Address - Country:US
Mailing Address - Phone:602-675-4861
Mailing Address - Fax:
Practice Address - Street 1:6218 W RAYMOND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043
Practice Address - Country:US
Practice Address - Phone:602-675-4861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness