Provider Demographics
NPI:1336747518
Name:MOORE, RASHA IMAN (ADMIN, AFH)
Entity Type:Individual
Prefix:
First Name:RASHA
Middle Name:IMAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:ADMIN, AFH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3611
Mailing Address - Country:US
Mailing Address - Phone:262-417-6800
Mailing Address - Fax:414-988-6233
Practice Address - Street 1:6112 N 37TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-3611
Practice Address - Country:US
Practice Address - Phone:262-417-6800
Practice Address - Fax:414-988-6233
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00175143747A0650X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral DisturbancesGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty