Healthcare Provider Details

I. General information

NPI: 1710489976
Provider Name (Legal Business Name): MORAVIAN ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 PHILLIPS AVE STE A
GREENSBORO NC
27405-5357
US

IV. Provider business mailing address

2515 PHILLIPS AVE STE A
GREENSBORO NC
27405-5357
US

V. Phone/Fax

Practice location:
  • Phone: 336-542-0581
  • Fax: 336-542-0464
Mailing address:
  • Phone: 336-542-0581
  • Fax: 336-542-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-041-1142
License Number StateNC

VIII. Authorized Official

Name: MS. MEGAN COMMEDO MORAVIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-542-0581