Active NPI
Moon River, LLC
- Home Health Agency
- Marietta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- MOON RIVER, LLC
- Practice address
- 790 Oak Trail Dr.
Marietta, GA 30062-7502 - Phone
- (770) 977-6866
- Fax
- (770) 977-6887
- NPI assigned
- Oct 13, 2011
- Last updated
- Oct 13, 2011
- Organization subpart
- Yes
- Parent organization
- MOON RIVER, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Maria T Smith, PT
- Title
- President
- Phone
- (770) 977-6866
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | NU | Primary |
Addresses
Primary practice location
790 Oak Trail Dr.
Marietta, GA 30062-7502
Mailing address
790 Oak Trail Dr.
Marietta, GA 30062-7502
Phone (770) 977-6866
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223654765A | Medicaid | GA |
Other names 1
- Therapy Services BCW
National Provider Directory
National Provider Directory- Tax ID family
- Moon River LLC
- Part of
- Moon River LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Early Intervention Provider Agency
- Marietta, GA
- NPI 1942639539
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Physical Therapist
- Woodstock, GA
- NPI 1942423835
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1318464000000",
"number": "1306121017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 OAK TRAIL DR.",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300627502",
"telephone_number": "770-977-6866",
"fax_number": "770-977-6887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 OAK TRAIL DR.",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300627502",
"telephone_number": "770-977-6866",
"fax_number": "770-977-6887"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOON RIVER, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MOON RIVER, LLC",
"enumeration_date": "2011-10-13",
"last_updated": "2011-10-13",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "MARIA",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "770-977-6866",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "223654765A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Therapy Services BCW",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.