1528182813 NPI number — MOORE FAMILY CARE HOME INC. #1 & #2

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528182813 NPI number — MOORE FAMILY CARE HOME INC. #1 & #2

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOORE FAMILY CARE HOME INC. #1 & #2
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:
1528182813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 E CHARITY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSE HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28458-8473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-289-7183
Provider Business Mailing Address Fax Number:
910-289-3285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 E CHARITY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSE HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28458-8473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-289-7183
Provider Business Practice Location Address Fax Number:
910-289-3285
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
ERNESTINE
Authorized Official Middle Name:
BONEY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
910-289-7183

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  FCL-031-005 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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