Provider Demographics
NPI: | 1558544130 |
---|---|
Name: | MORIAH, INCORPORATED |
Entity Type: | Organization |
Organization Name: | MORIAH, INCORPORATED |
Other - Org Name: | EISENHOWER CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | BILLING AND COLLECTIONS MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TANJA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TADDONIO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 734-677-0070 |
Mailing Address - Street 1: | 3200 E EISENHOWER PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | ANN ARBOR |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48108-3231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 734-677-0070 |
Mailing Address - Fax: | 734-677-0890 |
Practice Address - Street 1: | 3200 E EISENHOWER PKWY |
Practice Address - Street 2: | |
Practice Address - City: | ANN ARBOR |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48108-3231 |
Practice Address - Country: | US |
Practice Address - Phone: | 734-677-0070 |
Practice Address - Fax: | 734-677-0890 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-12-06 |
Last Update Date: | 2020-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
101Y00000X, 103K00000X, 1041C0700X, 163WP0808X, 163WW0000X, 164W00000X, 174H00000X, 235Z00000X, 251S00000X, 261QM0801X, 320600000X, 320800000X, 323P00000X | ||
MI | AL810015274 | 320700000X |
MI | SA0810348 | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Multi-Specialty |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | Group - Multi-Specialty | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Multi-Specialty | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Group - Multi-Specialty |