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General NPI Number Information
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NPI Number | 1134599590
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Entity Type | Organization
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Legal Business Name | MORAVIAN FAMILY CARE HOME
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 2905 HOLMES RD
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City | GREENSBORO
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State | NC
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Zip | 27405-4621
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Country | US
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Telephone | 336-554-3486
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Fax | 336-554-3486
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Provider Business Mailing Address
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Address Line | 7604 FAIRHAVEN RD
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City | BROWNS SUMMIT
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State | NC
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Zip | 27214-9643
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Country | US
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Telephone | 336-554-3486
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Fax | 336-358-1729
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN COMMEDO MORAVIAN
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Credential |
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Telephone | 336-554-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 041-1025
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License Number State | NC
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