Healthcare Provider Details

I. General information

NPI: 1154376747
Provider Name (Legal Business Name): MOORE GENUINE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ANDERSON ST
AUGUSTA WI
54722-9002
US

IV. Provider business mailing address

711 ANDERSON ST LOWER LEVEL
AUGUSTA WI
54722-9002
US

V. Phone/Fax

Practice location:
  • Phone: 715-286-2734
  • Fax: 715-286-2736
Mailing address:
  • Phone: 715-286-2734
  • Fax: 715-286-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE MOORE
Title or Position: MEMBER
Credential:
Phone: 715-286-2734