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General NPI Number Information
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NPI Number | 1811778269
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Entity Type | Organization
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Legal Business Name | MOVING MOUNTAIN SUPPORTIVE HOUSING
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 4404 W BETHANY HOME RD APT 56
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City | GLENDALE
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State | AZ
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Zip | 85301-5423
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Country | US
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Telephone | 626-381-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 4404 W BETHANY HOME RD APT 56
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City | GLENDALE
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State | AZ
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Zip | 85301-5423
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Country | US
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Telephone | 626-381-8963
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVETTE FLOYD
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Credential |
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Telephone | 626-381-8963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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