Healthcare Provider Details

I. General information

NPI: 1356876221
Provider Name (Legal Business Name): MOORE COUNSELING AND MEDIATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22639 EUCLID AVE
EUCLID OH
44117-1622
US

IV. Provider business mailing address

22639 EUCLID AVE
EUCLID OH
44117-1622
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax: 216-404-1901
Mailing address:
  • Phone: 216-404-1900
  • Fax: 216-404-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN.413369
License Number StateOH

VIII. Authorized Official

Name: MARTINA MOORE
Title or Position: CEO
Credential:
Phone: 216-404-1900