Basic Information
| Provider Information | |||||||||
| NPI: | 1992308977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORIAH, INCORPORATED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 E EISENHOWER PKWY | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346770070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3879 PACKARD ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481082011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344126485 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2020 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | TADDONIO | ||||||||
| AuthorizedOfficialFirstName: | TANJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AND COLLECTIONS MGR | ||||||||
| AuthorizedOfficialTelephone: | 7344126485 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MORIAH, INCORPORATED | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 103TA0400X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 104100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 2084P0802X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.