Provider Demographics
NPI:1164202750
Name:MOSS, CASEY M
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:M
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29324-0042
Mailing Address - Country:US
Mailing Address - Phone:864-564-3218
Mailing Address - Fax:
Practice Address - Street 1:880 CHERRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:SC
Practice Address - Zip Code:29324-2930
Practice Address - Country:US
Practice Address - Phone:864-564-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty