Rasha Iman Moore, ADMIN, AFH

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

0017514 Issued in WI

Practice address

6112 N 37TH St
Milwaukee, WI 53209-3611

Phone

(262) 417-6800

Fax

(414) 988-6233

NPI assigned

Oct 11, 2020

Last updated

Oct 12, 2020By the provider in NPPES

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": "1602374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1336747518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6112 N 37TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532093611",
            "telephone_number": "262-417-6800",
            "fax_number": "414-988-6233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6112 N 37TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532093611",
            "telephone_number": "262-417-6800",
            "fax_number": "414-988-6233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RASHA",
        "middle_name": "IMAN",
        "credential": "ADMIN, AFH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-11",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "WI",
            "license": "0017514",
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "WI",
            "license": "0017514",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monifa Moore
• Nidra Suwan Moore, R.N.
• Patrice Moore, LPC
• Peggy Kay Moore, OT
• Phillip Moore, MA LPC-IT, SAC-IT
• Ronda Denise Moore, APSW
• Rosann Moore, L.P.N
• Shamaine Moore
• Tania Sheri Moore, REGISTERED NURSE
• Tinja Camilla Moore, RN

• Assisted Living Facility (Behavioral Disturbances) in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Assisted Living Facility (Behavioral Disturbances) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; 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.