Provider Demographics
NPI:1972950053
Name:HUDSON INTEGRATIVE HEALTH HOME, LLC
Entity type:Organization
Organization Name:HUDSON INTEGRATIVE HEALTH HOME, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-442-6444
Mailing Address - Street 1:1200 28TH ST
Mailing Address - Street 2:S-100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1924
Mailing Address - Country:US
Mailing Address - Phone:303-442-6444
Mailing Address - Fax:303-442-4505
Practice Address - Street 1:1200 28TH ST
Practice Address - Street 2:S-100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1924
Practice Address - Country:US
Practice Address - Phone:303-442-6444
Practice Address - Fax:303-442-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty