Provider Demographics
NPI:1942876800
Name:HUDSON, FELICIA (PCA)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:ANN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCA
Mailing Address - Street 1:11812 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1948
Mailing Address - Country:US
Mailing Address - Phone:216-551-6734
Mailing Address - Fax:
Practice Address - Street 1:21625 CHAGRIN BLVD STE 260
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5363
Practice Address - Country:US
Practice Address - Phone:216-634-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization