Moda Human Services L.L.C

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

MODA HUMAN SERVICES L.L.C

Practice address

4420 Edrem Ave
Winston Salem, NC 27101-2108

Phone

(336) 725-9395

Fax

(336) 724-9365

NPI assigned

Mar 20, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Malebogo Nanzala Samuzala

Title

Owner

Phone

(336) 705-0643

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237507200000",
    "number": "1013158039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1073",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271021073",
            "telephone_number": "336-725-9395",
            "fax_number": "336-724-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 EDREM AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012108",
            "telephone_number": "336-725-9395",
            "fax_number": "336-724-9365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODA HUMAN SERVICES L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-20",
        "last_updated": "2009-03-20",
        "status": "A",
        "authorized_official_last_name": "SAMUZALA",
        "authorized_official_first_name": "MALEBOGO",
        "authorized_official_middle_name": "NANZALA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-705-0643",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kesean Legrant Mobley, LCSWA
• Jonathan Christian Mochnick, D.M.D.
• Linda Thomas Mock, MA CCC/A
• Monique Ladosca Mock, CNA, MED TECH
• Merritt Mocock Adams, M.D.
• John Modarress, MD
• Modern Hope of North Carolina
• Mona Modi
• David M Modlin, MSW, LCSW
• Lillykutty Abraham Modoor, NURSE PRACTITIONER

• Mental Illness Community Based Residential Treatment Facility in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Illness Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.