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General NPI Number Information
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NPI Number | 1467439299
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Entity Type | Organization
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Legal Business Name | MOORE HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 2611 W 46TH AVE
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City | AMARILLO
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State | TX
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Zip | 79110-1735
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Country | US
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Telephone | 803-355-6517
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Fax | 806-355-4190
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Provider Business Mailing Address
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Address Line | 2611 W 46TH AVE
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City | AMARILLO
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State | TX
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Zip | 79110-1735
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Country | US
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Telephone | 803-355-6517
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Fax | 806-355-4190
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Authorized Official
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Title or Position | REGIONAL ADMINISTRATOR
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Name | MRS. ANGELIN DICKSON
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Credential | LNFA
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Telephone | 806-259-3566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 111093
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License Number State | TX
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