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Organization
MOHER FAMILY CARE
Active
Organization
MOHER FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAVARIUS J MOORE ADMINISTRATOR (SIC)
(804) 624-3515
Entity
Organization
Contact information
Practice address
206 FRIENDLY RD, BURLINGTON, NC 27217-2502
(804) 624-3515
Mailing address
206 FRIENDLY RD, BURLINGTON, NC 27217-2502
(804) 624-3515
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FCL-001-107
—
NC
Enumeration date
05/31/2019
Last updated
05/31/2019
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