Healthcare Provider Details

I. General information

NPI: 1205710068
Provider Name (Legal Business Name): DESIREE RENEE HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 HILTON RD
CLEVELAND OH
44112-1525
US

IV. Provider business mailing address

1997 HILTON RD
CLEVELAND OH
44112-1525
US

V. Phone/Fax

Practice location:
  • Phone: 216-338-2190
  • Fax:
Mailing address:
  • Phone: 216-338-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: