Provider Demographics
NPI:1649303744
Name:HUDSON'S COUNTRY MANOR, INC
Entity type:Organization
Organization Name:HUDSON'S COUNTRY MANOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ONDREA
Authorized Official - Middle Name:DEMARIKO
Authorized Official - Last Name:LOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-501-3761
Mailing Address - Street 1:9842 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7710
Mailing Address - Country:US
Mailing Address - Phone:269-323-9752
Mailing Address - Fax:
Practice Address - Street 1:9842 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7710
Practice Address - Country:US
Practice Address - Phone:269-323-9752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities