MEDICARE: MOORE ADULT CARE 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366811325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE ADULT CARE LLC

Provider Business Mailing Address
First Line	:	15780 WILDEMERE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-1440
Country	:	US
Telephone Number	:	313-445-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	15780 WILDEMERE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48238-1440
Country	:	US
Telephone Number	:	313-445-4765
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. YOLANDA N MOORE
Credential	:
Telephone Number	:	313-445-4765

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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