Provider Demographics
NPI:1811778269
Name:MOVING MOUNTAIN SUPPORTIVE HOUSING
Entity type:Organization
Organization Name:MOVING MOUNTAIN SUPPORTIVE HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-381-8963
Mailing Address - Street 1:4404 W BETHANY HOME RD APT 56
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-5423
Mailing Address - Country:US
Mailing Address - Phone:626-381-8963
Mailing Address - Fax:
Practice Address - Street 1:4404 W BETHANY HOME RD APT 56
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-5423
Practice Address - Country:US
Practice Address - Phone:626-381-8963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No177F00000XOther Service ProvidersLodging
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)