Provider Demographics
NPI:1013585405
Name:MORIAH, INCORPORATED
Entity Type:Organization
Organization Name:MORIAH, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE AND CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:734-677-0070
Mailing Address - Street 1:3200 E EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3231
Mailing Address - Country:US
Mailing Address - Phone:734-677-0070
Mailing Address - Fax:734-677-0890
Practice Address - Street 1:29991 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:SELFRIDGE ANGB
Practice Address - State:MI
Practice Address - Zip Code:48045-4957
Practice Address - Country:US
Practice Address - Phone:734-677-0070
Practice Address - Fax:734-677-0890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORIAH INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities