Provider Demographics
NPI:1205815198
Name:MOSS HOME HEALTH, INC
Entity Type:Organization
Organization Name:MOSS HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:CHCE
Authorized Official - Phone:318-628-5651
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-0271
Mailing Address - Country:US
Mailing Address - Phone:318-628-5651
Mailing Address - Fax:318-628-5685
Practice Address - Street 1:404 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-2722
Practice Address - Country:US
Practice Address - Phone:318-628-5651
Practice Address - Fax:318-628-5685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA460251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA197466Medicare ID - Type UnspecifiedHOME HEALTH LICENCE