Provider Demographics
NPI:1417541152
Name:MOORER, NIJA DIANNA (REHABILITATION SPECI)
Entity Type:Individual
Prefix:
First Name:NIJA
Middle Name:DIANNA
Last Name:MOORER
Suffix:
Gender:F
Credentials:REHABILITATION SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27591 BRUSH AVE # 11
Mailing Address - Street 2:27591 BRUSH AVE # 11
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-609-8221
Mailing Address - Fax:
Practice Address - Street 1:27591 BRUSH AVE # 11
Practice Address - Street 2:27591 BRUSH AVE # 11
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-609-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home