Provider Demographics
NPI:1356853949
Name:MORAVIAN FAMILY CARE HOME LLC
Entity Type:Organization
Organization Name:MORAVIAN FAMILY CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:COMMEDO
Authorized Official - Last Name:MORAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-542-0581
Mailing Address - Street 1:3428 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3254
Mailing Address - Country:US
Mailing Address - Phone:336-542-0581
Mailing Address - Fax:
Practice Address - Street 1:7604 FAIRHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9643
Practice Address - Country:US
Practice Address - Phone:336-554-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-1142320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities