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General NPI Number Information
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NPI Number | 1043033459
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Entity Type | Individual
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Provider Name | CHANELL RENEE MOORE
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1674 MAXEN DR
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City | AKRON
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State | OH
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Zip | 44307-1031
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Country | US
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Telephone | 330-234-1307
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Fax |
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Provider Business Mailing Address
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Address Line | 1674 MAXEN DR
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City | AKRON
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State | OH
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Zip | 44307-1031
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Country | US
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Telephone | 330-234-1307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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