Provider Demographics
NPI:1942806120
Name:MOODY'S FAMILY SERVICES
Entity Type:Organization
Organization Name:MOODY'S FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MA
Authorized Official - Phone:757-971-4535
Mailing Address - Street 1:1585 BRIARFIELD RD APT 38
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4847
Mailing Address - Country:US
Mailing Address - Phone:757-971-4535
Mailing Address - Fax:757-838-7663
Practice Address - Street 1:1971 E PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1338
Practice Address - Country:US
Practice Address - Phone:757-971-4535
Practice Address - Fax:757-838-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health