Provider Demographics
NPI:1780031021
Name:TERESA MOORE
Entity Type:Organization
Organization Name:TERESA MOORE
Other - Org Name:GIFTED HANDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:407-914-6831
Mailing Address - Street 1:108 BRIDGEPORT WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4139
Mailing Address - Country:US
Mailing Address - Phone:407-914-6831
Mailing Address - Fax:
Practice Address - Street 1:108 BRIDGEPORT WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4139
Practice Address - Country:US
Practice Address - Phone:407-914-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL287241251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016520200Medicaid