# IVY FLO MOORE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366864795
- **Authorized official:** IVY FLO MOORE (OWNER)
- **Authorized official phone:** (941) 627-5983

## Contact information

- **Practice address:** 23145 GRAY AVE, PORT CHARLOTTE, FL 33980-8587
- **Practice address phone:** (941) 627-5983
- **Mailing address:** 23145 GRAY AVE, PORT CHARLOTTE, FL 33980-8587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 6906285 | FL | Yes |

## Other

- **Enumeration date:** 01/21/2014
- **Last updated:** 01/21/2014