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General NPI Number Information
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NPI Number | 1326994047
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Entity Type | Organization
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Legal Business Name | HURLEY'S PHOENIX SUPPORT CENTER
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 276 BALL RD LOT 9
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City | RAVEN
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State | VA
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Zip | 24639
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Country | US
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Telephone | 276-970-8366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | RAVEN
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State | VA
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Zip | 24639-0102
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Country | US
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Telephone | 276-970-8366
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | ASHLEY BROOKE HURLEY
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Credential | CAMARP
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Telephone | 276-970-8366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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