Healthcare Provider Details

I. General information

NPI: 1538049044
Provider Name (Legal Business Name): MOSES MAKOR BSN-RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SARAH DARKOMA LPN

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MAIN ST
CHERRY VALLEY MA
01611-3143
US

IV. Provider business mailing address

231 MAIN ST
CHERRY VALLEY MA
01611-3143
US

V. Phone/Fax

Practice location:
  • Phone: 508-873-5711
  • Fax:
Mailing address:
  • Phone: 508-873-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN277193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: