MEDICARE: MOSEZIT MOORE HOUSE ,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1265038525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSEZIT MOORE HOUSE ,LLC

Provider Business Mailing Address
First Line	:	1797 S GREEN RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4209
Country	:	US
Telephone Number	:	440-991-6347
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 S GREEN RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-4209
Country	:	US
Telephone Number	:	440-991-6347
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LORRAINE GLOVER
Credential	:
Telephone Number	:	440-991-6347

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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Directions to “MOSEZIT MOORE HOUSE ,LLC ” Practice Location

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