Provider Demographics
NPI:1528182813
Name:MOORE FAMILY CARE HOME INC. #1 & #2
Entity Type:Organization
Organization Name:MOORE FAMILY CARE HOME INC. #1 & #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERNESTINE
Authorized Official - Middle Name:BONEY
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-289-7183
Mailing Address - Street 1:181 E CHARITY RD
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-8473
Mailing Address - Country:US
Mailing Address - Phone:910-289-7183
Mailing Address - Fax:910-289-3285
Practice Address - Street 1:181 E CHARITY RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-8473
Practice Address - Country:US
Practice Address - Phone:910-289-7183
Practice Address - Fax:910-289-3285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-031-005305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC$$$$$$$$$OtherSOCIAL SECURITY NUMBER