MEDICARE: CHARLOTTA LORETTA MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency		LA

General Provider Information

NPI Number	:	1548135775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTA LORETTA MOORE

Provider Business Mailing Address
First Line	:	11746 S HARRELLS FERRY RD STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2375
Country	:	US
Telephone Number	:	662-347-8163
Fax Number	:

Provider Business Practice Location Address
First Line	:	11746 S HARRELLS FERRY RD STE D
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2375
Country	:	US
Telephone Number	:	662-347-8163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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