Healthcare Provider Details

I. General information

NPI: 1992308977
Provider Name (Legal Business Name): MORIAH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3879 PACKARD ST UNIT B
ANN ARBOR MI
48108-2011
US

IV. Provider business mailing address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

V. Phone/Fax

Practice location:
  • Phone: 734-412-6485
  • Fax:
Mailing address:
  • Phone: 734-677-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANJA TADDONIO
Title or Position: BILLING AND COLLECTIONS MGR
Credential:
Phone: 734-412-6485