Provider Demographics
NPI:1275798522
Name:LJ MOORE INCORPORATED
Entity Type:Organization
Organization Name:LJ MOORE INCORPORATED
Other - Org Name:COMMUNITY DAY SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:YVONNIE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-595-8760
Mailing Address - Street 1:4743 BEACON PARK LN
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9220
Mailing Address - Country:US
Mailing Address - Phone:336-595-8760
Mailing Address - Fax:
Practice Address - Street 1:2306 CRAGMORE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-2458
Practice Address - Country:US
Practice Address - Phone:336-595-8760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LJ MOORE INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1694956251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services