Mt. Moriah United Methodist Church, Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

9038 Issued in FL

Legal business name

MT. MORIAH UNITED METHODIST CHURCH, INC

Practice address

3919 Saint Augustine Rd
Jacksonville, FL 32207-6638

Phone

(904) 396-6918

Fax

(904) 396-1444

NPI assigned

Dec 6, 2009

Organization subpart

No

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

Authorized official

Name

Deloris Demps

Title

Administrator

Phone

(904) 396-6918

Specialties & licenses 1

Addresses

Other names 1

• Mt. Moriah Adult Daycare Other name

Locations

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

{
    "created_epoch": "1260057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260057600000",
    "number": "1366770133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322076638",
            "telephone_number": "904-396-6918",
            "fax_number": "904-396-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 SAINT AUGUSTINE RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322076638",
            "telephone_number": "904-396-6918",
            "fax_number": "904-396-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT. MORIAH UNITED METHODIST CHURCH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-06",
        "last_updated": "2009-12-06",
        "status": "A",
        "authorized_official_last_name": "DEMPS",
        "authorized_official_first_name": "DELORIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-396-6918"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "9038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. Moriah Adult Daycare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Adult Care Home Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2009; 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.