Basic Information
| Provider Information | |||||||||
| NPI: | 1558544130 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MORIAH, INCORPORATED | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EISENHOWER CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E EISENHOWER PKWY | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346770070 | ||||||||
| FaxNumber: | 7346770890 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 E EISENHOWER PKWY | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346770070 | ||||||||
| FaxNumber: | 7346770890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2007 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TADDONIO | ||||||||
| AuthorizedOfficialFirstName: | TANJA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BILLING AND COLLECTIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7346770070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 163WP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WW0000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Wound Care | 164W00000X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Licensed Practical Nurse | 174H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Health Educator | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 251S00000X | N | Agencies | Community/Behavioral Health | 320600000X | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320700000X | AL810015274 | MI | N | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | SA0810348 | MI | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.