NPIMap

Organization Active NPI

Mooreresidence Home, Inc

  • Mental Health Counselor
  • Jamaica, NY
National Provider Identifier
1154468015
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
003801-1 Issued in NY
Legal business name
MOORERESIDENCE HOME, INC
Practice address
16305 107TH Ave
Suite 1R
Jamaica, NY 11433-2101
Phone
(718) 739-7420
Fax
(718) 487-3722
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Ms. Donna A Moore, MHS, LMHC
Title
Founder President
Phone
(718) 739-7420

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 10889 NY
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 003801-1 NY Primary
Licensed Practical NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 164W00000X 209905-1 NY

Addresses

Primary practice location

16305 107TH Ave
Suite 1R
Jamaica, NY 11433-2101

Mailing address

P.O. Box 650 439
Fresh Meadows, NY 11365
Phone (718) 739-7420

Other names 1

  • Moore Residence Home, Inc. Multi Purpose center Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1154468015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 650 439",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "11365",
            "telephone_number": "718-739-7420",
            "fax_number": "718-487-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16305 107TH AVE",
            "address_2": "SUITE 1R",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114332101",
            "telephone_number": "718-739-7420",
            "fax_number": "718-487-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORERESIDENCE HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "FOUNDER  PRESIDENT",
        "authorized_official_telephone_number": "718-739-7420",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MHS, LMHC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "10889",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "003801-1",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "209905-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore Residence Home, Inc. Multi Purpose center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jamaica, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.