Provider Demographics
NPI:1316446297
Name:HURLEY HOUSE, INC.
Entity type:Organization
Organization Name:HURLEY HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:COLCORD
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, LADAC1
Authorized Official - Phone:781-891-4323
Mailing Address - Street 1:PO BOX 540662
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02454-0662
Mailing Address - Country:US
Mailing Address - Phone:781-891-4323
Mailing Address - Fax:781-891-9293
Practice Address - Street 1:12 LOWELL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5254
Practice Address - Country:US
Practice Address - Phone:781-891-4323
Practice Address - Fax:781-891-9293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0222324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility