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General NPI Number Information
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NPI Number | 1518360460
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Entity Type | Organization
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Legal Business Name | MOORE HOME CARE LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 2811 MYRTLEWOOD DR
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City | DUMFRIES
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State | VA
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Zip | 22026-4572
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Country | US
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Telephone | 703-672-1282
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Fax | 703-441-9069
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Provider Business Mailing Address
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Address Line | 5616 - I OX ROAD # 7171
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-9998
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Country | US
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Telephone | 703-672-1282
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Fax | 703-441-9069
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | TONI NATASHA MOORE
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Credential | L.P.N. #0002049528
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Telephone | 703-672-1282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HCO-151194
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License Number State |
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