Active NPI
Moon River, LLC
- Early Intervention Provider Agency
- Marietta, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Early Intervention Provider Agency
- Legal business name
- MOON RIVER, LLC
- Practice address
- 2000 First Dr
Suite 340
Marietta, GA 30062-7739 - Phone
- (770) 977-6866
- Fax
- (770) 783-8639
- NPI assigned
- Nov 5, 2013
- Last updated
- Nov 5, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Maria Teresa 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 |
|---|---|---|---|---|
| Early Intervention Provider Agency | 252Y00000X | Primary |
Addresses
Primary practice location
2000 First Dr
Suite 340
Marietta, GA 30062-7739
Mailing address
790 Oak Trail Dr
Marietta, GA 30062-7502
Phone (770) 977-6866
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 223654765A | Medicaid | GA |
National Provider Directory
National Provider Directory- Tax ID family
- Moon River LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Marietta, GA
- NPI 1306121017
Locations
2000 1st Dr
Ste 340
Marietta, GA 30062
Phone (770) 977-6866
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": "1383609600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1383609600000",
"number": "1942639539",
"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": "770-783-8639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 FIRST DR",
"address_2": "SUITE 340",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300627739",
"telephone_number": "770-977-6866",
"fax_number": "770-783-8639"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOON RIVER, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-11-05",
"last_updated": "2013-11-05",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "MARIA",
"authorized_official_middle_name": "TERESA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "770-977-6866",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "252Y00000X",
"taxonomy_group": "",
"desc": "Early Intervention Provider Agency",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "223654765A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}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 Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.