MEDICARE: MRS. DEENA M MOYE LIVINGSTON B.A

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1851501340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEENA M MOYE LIVINGSTON B.A

Provider Business Mailing Address
First Line	:	3122 PINE CONE TRL
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-6523
Country	:	US
Telephone Number	:	336-987-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 PINE CONE TRL
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-6523
Country	:	US
Telephone Number	:	336-987-0944
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/19/2008

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