Delena Renee Moore

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

AS390367863 Issued in MI

Practice address

722 N Edwards St
Kalamazoo, MI 49007-3505

Phone

(269) 363-6137

NPI assigned

Jul 15, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1073997508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 N EDWARDS ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490073505",
            "telephone_number": "269-363-6137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 N EDWARDS ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490073505",
            "telephone_number": "269-363-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DELENA",
        "middle_name": "RENEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MI",
            "license": "AS390367863",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "MI",
            "license": "AS390367863",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie L Moore, MA, LMSW, CAAC
• Charles Moore, M.D.
• Courtney Christina Moore, BSW
• Dale G Moore, C.R.N.A.
• Dejanique Moore
• Emma Jean Moore
• Gwendolyn Layette Moore, RN
• Mary Moore, MA
• Pam Moore, MSW, LLMSW
• Rhonda Lynn Moore, DTLLP

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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.