Organization
MOSES GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY-ANN MOSES (MGR)
(201) 214-8142
Entity
Organization
Contact information
Practice address
4273 SW DIDO DR, PORT ST LUCIE, FL 34953-6434
(201) 214-8142
Mailing address
4273 SW DIDO DR, PORT ST LUCIE, FL 34953-6434
(201) 214-8142
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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