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General NPI Number Information
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NPI Number | 1346588340
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Entity Type | Organization
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Legal Business Name | MOORE COLE GROUP, INC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 208 FULHAM CIR
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City | RICHMOND
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State | VA
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Zip | 23227-1711
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Country | US
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Telephone | 804-405-1798
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Fax | 804-643-1440
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Provider Business Mailing Address
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Address Line | 208 FULHAM CIR
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City | RICHMOND
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State | VA
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Zip | 23227-1711
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Country | US
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Telephone | 804-405-1798
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Fax | 804-643-1440
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESSE ALBERT MOORE
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Credential |
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Telephone | 804-677-6209
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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 | 1536-01-0001
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License Number State | VA
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