Healthcare Provider Details

I. General information

NPI: 1326994047
Provider Name (Legal Business Name): HURLEY'S PHOENIX SUPPORT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 BALL RD LOT 9
RAVEN VA
24639
US

IV. Provider business mailing address

PO BOX 102
RAVEN VA
24639-0102
US

V. Phone/Fax

Practice location:
  • Phone: 276-970-8366
  • Fax:
Mailing address:
  • Phone: 276-970-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BROOKE HURLEY
Title or Position: FOUNDER & CEO
Credential: CAMARP
Phone: 276-970-7517