Provider Demographics
NPI:1508029315
Name:MORIAH HARBOR INDUSTRIES INC
Entity Type:Organization
Organization Name:MORIAH HARBOR INDUSTRIES INC
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:PEMBERTON
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-370-1618
Mailing Address - Street 1:11291 ARBOR CREEK DR
Mailing Address - Street 2:APT #1134
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-0233
Mailing Address - Country:US
Mailing Address - Phone:804-370-1618
Mailing Address - Fax:
Practice Address - Street 1:10800 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4724
Practice Address - Country:US
Practice Address - Phone:804-332-5359
Practice Address - Fax:804-378-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO09473251E00000X
VAHCO08473311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home