Provider Demographics
NPI:1710489976
Name:MORAVIAN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MORAVIAN ENTERPRISES, LLC
Other - Org Name:PROLIFIC COMMUNITY RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:COMMEDO
Authorized Official - Last Name:MORAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-542-0581
Mailing Address - Street 1:2515 PHILLIPS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5357
Mailing Address - Country:US
Mailing Address - Phone:336-542-0581
Mailing Address - Fax:336-542-0464
Practice Address - Street 1:2515 PHILLIPS AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5357
Practice Address - Country:US
Practice Address - Phone:336-542-0581
Practice Address - Fax:336-542-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 251E00000X, 310400000X
NCMHL-041-1142320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty