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General NPI Number Information
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NPI Number | 1942806120
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Entity Type | Organization
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Legal Business Name | MOODY'S FAMILY SERVICES
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Dates
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Enumeration Date | 12/11/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 1971 E PEMBROKE AVE
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City | HAMPTON
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State | VA
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Zip | 23663-1338
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Country | US
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Telephone | 757-971-4535
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Fax | 757-838-7663
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Provider Business Mailing Address
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Address Line | 1585 BRIARFIELD RD APT 38
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City | HAMPTON
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State | VA
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Zip | 23666-4847
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Country | US
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Telephone | 757-971-4535
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Fax | 757-838-7663
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. KENNETH PAUL MOODY SR.
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Credential | MA
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Telephone | 757-971-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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