Healthcare Provider Details

I. General information

NPI: 1073107975
Provider Name (Legal Business Name): MONIQUE L HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 ORCHARD RD
CLEVELAND HEIGHTS OH
44121-2411
US

IV. Provider business mailing address

3941 ORCHARD RD
CLEVELAND HEIGHTS OH
44121-2411
US

V. Phone/Fax

Practice location:
  • Phone: 216-256-4875
  • Fax:
Mailing address:
  • Phone: 216-256-4875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: