Provider Demographics
NPI:1124502091
Name:KATHLEEN AND RANDOLPH HUDSON, LLC. DBA CHOICES IN LIVING
Entity type:Organization
Organization Name:KATHLEEN AND RANDOLPH HUDSON, LLC. DBA CHOICES IN LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TAX MATTERS PERSON
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-541-1211
Mailing Address - Street 1:134 SW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7135
Mailing Address - Country:US
Mailing Address - Phone:239-541-1211
Mailing Address - Fax:
Practice Address - Street 1:3812 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-3323
Practice Address - Country:US
Practice Address - Phone:239-540-6813
Practice Address - Fax:239-540-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care