Healthcare Provider Details

I. General information

NPI: 1982272365
Provider Name (Legal Business Name): MORIAH, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
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: 734-677-0890
Mailing address:
  • Phone: 734-677-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM MUCHA
Title or Position: COMPLIANCE AND CONTRACTS MANAGER
Credential: MSA
Phone: 734-677-0070