Provider Demographics
NPI:1518360460
Name:MOORE HOME CARE LLC
Entity Type:Organization
Organization Name:MOORE HOME CARE LLC
Other - Org Name:ACTIKARE IN HOME RESPONSIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN #0002049528
Authorized Official - Phone:703-672-1282
Mailing Address - Street 1:5616 - I OX ROAD # 7171
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-9998
Mailing Address - Country:US
Mailing Address - Phone:703-672-1282
Mailing Address - Fax:703-441-9069
Practice Address - Street 1:2811 MYRTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-4572
Practice Address - Country:US
Practice Address - Phone:703-672-1282
Practice Address - Fax:703-441-9069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOORE HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HCO-151194253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care