Individual
DELENA RENEE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
722 N EDWARDS ST, KALAMAZOO, MI 49007-3505
(269) 363-6137
Mailing address
722 N EDWARDS ST, KALAMAZOO, MI 49007-3505
(269) 363-6137
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
AS390367863
MI
320700000X
Physical Disabilities Residential Treatment Facility
AS390367863
MI
Other
Enumeration date
07/15/2015
Last updated
07/15/2015
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