Provider Demographics
NPI:1801512686
Name:HORGAN, RICHARD K
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:HORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 NORTHRIDGE DR APT 45
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9001
Mailing Address - Country:US
Mailing Address - Phone:304-573-6907
Mailing Address - Fax:
Practice Address - Street 1:459 NORTHRIDGE DR APT 45
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9001
Practice Address - Country:US
Practice Address - Phone:304-573-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant