Provider Demographics
NPI:1225585722
Name:MOORE HOME PERSONAL CARE LLC
Entity Type:Organization
Organization Name:MOORE HOME PERSONAL CARE LLC
Other - Org Name:GRISWOLD HOME CARE FOR RALEIGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-435-0823
Mailing Address - Street 1:10940 RAVEN RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6611
Mailing Address - Country:US
Mailing Address - Phone:919-435-0823
Mailing Address - Fax:919-594-6001
Practice Address - Street 1:10940 RAVEN RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6611
Practice Address - Country:US
Practice Address - Phone:919-435-0823
Practice Address - Fax:919-594-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3207253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care