Provider Demographics
NPI:1588796403
Name:LJ MOORE INCORPORATED
Entity Type:Organization
Organization Name:LJ MOORE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-595-8760
Mailing Address - Street 1:4743 BEACON PARK LN
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9220
Mailing Address - Country:US
Mailing Address - Phone:336-595-8760
Mailing Address - Fax:336-595-8413
Practice Address - Street 1:4743 BEACON PARK LN
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9220
Practice Address - Country:US
Practice Address - Phone:336-595-8760
Practice Address - Fax:336-595-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408279Medicaid
NC8301139BMedicaid