Healthcare Provider Details

I. General information

NPI: 1497619183
Provider Name (Legal Business Name): MOOREBILITY OUTREACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 WOODLAWN ST
HOPEWELL VA
23860-4738
US

IV. Provider business mailing address

3404 WOODLAWN ST
HOPEWELL VA
23860-4738
US

V. Phone/Fax

Practice location:
  • Phone: 804-490-1538
  • Fax: 804-490-1538
Mailing address:
  • Phone: 804-490-1538
  • Fax: 804-490-1538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LETITIA MOORE
Title or Position: OWNER
Credential: BSW, QMHP, QDDP,
Phone: 804-490-1538