Healthcare Provider Details

I. General information

NPI: 1295951697
Provider Name (Legal Business Name): MOXIE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44905 CARVER DR
KENAI AK
99611-6742
US

IV. Provider business mailing address

44905 CARVER DRIVE
KENAI AK
99611
US

V. Phone/Fax

Practice location:
  • Phone: 907-260-7442
  • Fax:
Mailing address:
  • Phone: 907-260-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10770
License Number StateAK

VIII. Authorized Official

Name: DEBORAH SUE MCCARTHY
Title or Position: OWNER
Credential: RN
Phone: 907-260-7442