Provider Demographics
NPI:1619392255
Name:MOORE HEALTHCARE ENTERPRISES INC
Entity Type:Organization
Organization Name:MOORE HEALTHCARE ENTERPRISES INC
Other - Org Name:MIDDLETOWN NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-354-2223
Mailing Address - Street 1:131 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356-9772
Mailing Address - Country:US
Mailing Address - Phone:765-354-2223
Mailing Address - Fax:765-354-6111
Practice Address - Street 1:131 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356
Practice Address - Country:US
Practice Address - Phone:765-354-2223
Practice Address - Fax:765-354-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN155486313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100289600 AMedicaid