Individual
RICHARD LOWELL HURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
457 N MICHIGAN AVE, EDGERTON, OH 43517-9680
(419) 212-0947
Mailing address
457 N MICHIGAN AVE, EDGERTON, OH 43517-9680
(419) 212-0947
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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