MEDICARE: MONIQUE L HURD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073107975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE L HURD

Provider Business Mailing Address
First Line	:	3941 ORCHARD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-2411
Country	:	US
Telephone Number	:	216-256-4875
Fax Number	:

Provider Business Practice Location Address
First Line	:	3941 ORCHARD RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-2411
Country	:	US
Telephone Number	:	216-256-4875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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