Moore Genuine Care, LLC – Home Health Agency

Key facts

NPI: 1154376747
Entity type: Organization (NPI type 2)
Primary specialty: Home Health Agency 251E00000X
Legal business name: MOORE GENUINE CARE, LLC
Practice address: 711 Anderson St
Augusta, WI 54722-9002
Phone: (715) 286-2734
Fax: (715) 286-2736
NPI assigned: May 23, 2006
Organization subpart: No

Authorized official

Name: Charlotte Moore
Title: Member
Phone: (715) 286-2734

Medicare Care Compare: Home health agency

Listed as: Moore Genuine Care CCN 527297
Ownership: Proprietary
Certified: Oct 16, 2006
Medicare certification status: Active (Provider of Services file)
Services: Nursing, Home health aide

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
52D1056870	Moore Genuine Care LLC 711 Anderson St LL, Augusta, WI 54722	Certificate of waiver	Jul 26, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI

Home health agency certification: CCN 527297

Legal name: MOORE GENUINE CARE, LLC
Certification status: Active
Provider type (POS): Home health agency
Participating since: Oct 16, 2006
Last certification: Feb 9, 2021
Ownership / control type: Proprietary
Organization structure: Corporation · Proprietary
Incorporated: May 25, 2005 in WI
Enrollment address: 711 Anderson St
Augusta, WI 54722-9002

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since	Share
Charlotte Moore Individual	5% Or Greater Direct Ownership Interest	May 25, 2005	50%
	Corporate Officer Board Member	May 25, 2005	50%
	Corporate Director	May 25, 2005
Amy Vollrath Individual	W-2 Managing Employee Don	Jan 1, 2018
Gary D Moore Individual	5% Or Greater Direct Ownership Interest	May 25, 2006	50%
	Corporate Officer Board Member	May 25, 2005	50%
	Corporate Director Board Member	May 25, 2005	50%

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20060628000128	WI	Part a Provider - Home Health Agency	4880606300	Practice locations: Augusta, WI

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Home Health Agency	251E00000X			Yes

Addresses

Primary practice location

711 Anderson St
Augusta, WI 54722-9002

Mailing address

711 Anderson St
Lower Level
Augusta, WI 54722-9002
Phone (715) 286-2734

Other identifiers

Identifier	Type	State	Issuer
43114200	Medicaid	WI

Other providers in Augusta, WI

All providers in Augusta, WI · Home Health Agency in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.