Healthcare Provider Details

I. General information

NPI: 1659035723
Provider Name (Legal Business Name): KAIA S. HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 M 139
BENTON HARBOR MI
49022-5748
US

IV. Provider business mailing address

1485 M 139
BENTON HARBOR MI
49022-5711
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-0585
  • Fax: 269-927-1326
Mailing address:
  • Phone: 269-925-0585
  • Fax: 269-927-1326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: