Healthcare Provider Details

I. General information

NPI: 1508029315
Provider Name (Legal Business Name): MORIAH HARBOR INDUSTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MIDLOTHIAN TPKE SUITE 120
RICHMOND VA
23235-4724
US

IV. Provider business mailing address

11291 ARBOR CREEK DR APT #1134
RICHMOND VA
23233-0233
US

V. Phone/Fax

Practice location:
  • Phone: 804-332-5359
  • Fax: 804-378-0083
Mailing address:
  • Phone: 804-370-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO09473
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHCO08473
License Number StateVA

VIII. Authorized Official

Name: MR. S PEMBERTON HUTCHINSON
Title or Position: PRESIDENT
Credential:
Phone: 804-370-1618