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
StateLicense IDTaxonomies
101Y00000X, 103K00000X, 1041C0700X, 163WP0808X, 163WW0000X, 164W00000X, 174H00000X, 235Z00000X, 251S00000X, 261QM0801X, 320600000X, 320800000X, 323P00000X
MIAL810015274320700000X
MISA0810348324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical DisabilitiesGroup - Multi-Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Multi-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty