MEDICARE: R C MOORE VOCATIONAL SERVICES

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	347C00000X	Private Vehicle	81110	LA

General Provider Information

NPI Number	:	1396084042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R C MOORE VOCATIONAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 508
Second Line	:
City	:	VIOLET
State	:	LA
Zip	:	70092-0508
Country	:	US
Telephone Number	:	504-682-9110
Fax Number	:	504-682-9117

Provider Business Practice Location Address
First Line	:	7837 E SAINT BERNARD HWY
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5418
Country	:	US
Telephone Number	:	504-682-9110
Fax Number	:	504-682-9117

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. IRIS DIANE MOORE
Credential	:
Telephone Number	:	504-682-9110

Provider Enumeration Date	:	01/31/2013
Last Update Date	:	01/31/2013

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