1144727587 NPI number — MELISSA MOORE FOUNDATION FOR HEALTH AND WELLBEING

Table of content: NICOLE JULIANA MOSS MD (NPI 1821060856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144727587 NPI number — MELISSA MOORE FOUNDATION FOR HEALTH AND WELLBEING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MELISSA MOORE FOUNDATION FOR HEALTH AND WELLBEING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144727587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
237 STONE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMERICK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04048-3910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-651-0783
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 STONE HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMERICK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04048-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-651-0783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GAGNE
Authorized Official First Name:
CANDICE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
207-651-0783

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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