Moore House, Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

MOORE HOUSE, INC

Doing business as

Moore House

Practice address

3608 King St
Portsmouth, VA 23707-3128

Phone

(757) 966-1622

Fax

(757) 966-2802

NPI assigned

May 19, 2022

Organization subpart

No

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

Authorized official

Name

Ms. Miranda Frazier

Title

Assistant Chief Administrative Offi

Phone

(757) 966-1622

Specialties & licenses 1

Addresses

Other names 1

• Moore House Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 49G078

Legal name

MOORE HOUSE

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Apr 21, 2022

Last certification

Mar 31, 2022

Beds

5

Ownership / control type

Private (non-profit)

Facility address

3608 King Street
Portsmouth, VA 23707

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1518604677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4211 COUNTY STREET",
            "address_2": "ATTN: BUSINESS OFFICE",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073128",
            "telephone_number": "757-397-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 KING ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237073128",
            "telephone_number": "757-966-1622",
            "fax_number": "757-966-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE HOUSE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-19",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_title_or_position": "ASSISTANT CHIEF ADMINISTRATIVE OFFI",
        "authorized_official_telephone_number": "757-966-1622",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moore House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert John Monroe, MD
• Danielle Christine Monteil, M.D.
• William David Montes, DDS
• Andrew Houston Montgomery, MD
• Moore Hearts Moore Hands Home Healthcare
• Amia Moore
• Dorothy M Moore, PH.D., LPC, ACS
• Edna E. Moore, MSN, WHNP
• Evan Moore, MD
• Jeffrey Lee Moore Jr., D.O.

• Intellectual Disabilities Intermediate Care Facility in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Intellectual Disabilities Intermediate Care Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (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.