Provider Demographics
NPI:1902390149
Name:MODERN ALLY COMPANY, LLC
Entity Type:Organization
Organization Name:MODERN ALLY COMPANY, LLC
Other - Org Name:MODERN ALLY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-321-5583
Mailing Address - Street 1:1545 S BREIEL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6703
Mailing Address - Country:US
Mailing Address - Phone:937-321-5583
Mailing Address - Fax:
Practice Address - Street 1:1545 S BREIEL BLVD STE E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6703
Practice Address - Country:US
Practice Address - Phone:937-321-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health