Healthcare Provider Details

I. General information

NPI: 1053783811
Provider Name (Legal Business Name): MOORE FUN BEFORE AND AFTER SCHOOL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W OHIO ST SUITE 2000
INDIANAPOLIS IN
46204-1906
US

IV. Provider business mailing address

1519 W 27TH ST
INDIANAPOLIS IN
46208-5227
US

V. Phone/Fax

Practice location:
  • Phone: 317-966-0544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEVIN MOORE
Title or Position: PRESIDENT
Credential:
Phone: 317-966-0544