Healthcare Provider Details

I. General information

NPI: 1689488462
Provider Name (Legal Business Name): MOREMI RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5904 THOREAU AVE
FORT WAYNE IN
46815-6249
US

IV. Provider business mailing address

5904 THOREAU AVE
FORT WAYNE IN
46815-6249
US

V. Phone/Fax

Practice location:
  • Phone: 260-435-9402
  • Fax:
Mailing address:
  • Phone: 260-435-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MR. AYODEJI A SAVAGE
Title or Position: CEO
Credential: N/A
Phone: 260-435-9402