MEDICARE: BEVERLY MOORE

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1831660612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY MOORE

Provider Business Mailing Address
First Line	:	953 E 128TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-2583
Country	:	US
Telephone Number	:	216-785-4179
Fax Number	:

Provider Business Practice Location Address
First Line	:	953 E 128TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-2583
Country	:	US
Telephone Number	:	216-785-4179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	12/05/2018

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Directions to “ BEVERLY MOORE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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