Provider Demographics
NPI:1700940525
Name:HUDSBORNE ENTERPRISES, INC.
Entity Type:Organization
Organization Name:HUDSBORNE ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-993-1320
Mailing Address - Street 1:6400 NE HIGHWAY 99 STE G
Mailing Address - Street 2:PMB 364
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8748
Mailing Address - Country:US
Mailing Address - Phone:360-993-1320
Mailing Address - Fax:360-993-5321
Practice Address - Street 1:6108 NE HIGHWAY 99 STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8751
Practice Address - Country:US
Practice Address - Phone:360-993-1320
Practice Address - Fax:360-993-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA06312 MA14678225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty