ROSLYN MOORE , NPI 1588731970 — PHOENIX (AZ)

NPI 1588731970

13+ Years Experience Individual

ROSLYN MOORE

11/29/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1588731970
NPI NUMBER

About ROSLYN MOORE

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

ROSLYN MOORE is a provider established in PHOENIX, AZ. The NPI number of ROSLYN MOORE is 1588731970 and was assigned on 11/29/2006. The practitioners primary taxonomy code is: 385HR2055X with license number: 8559 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850415209
  • Phone: 6238730204
  • Address: 3132 W ALTA VISTA RD

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1588731970
  • Phone : 6238730204
  • Postalcode : 850415209
  • Address : 3132 W ALTA VISTA RD

Additional identifiers

  • Identifier: 917057
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer: AHCCCS ID

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Respite Care

  • Taxonomy code: 385HR2055X
  • License number: 8559
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.

Contacts:

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  • ROSLYN MOORE
  • Address : 3132 W ALTA VISTA RD
  • Region : PHOENIX, AZ
  • NPI : 1588731970
  • Phone : 6238730204
  • Postalcode : 850415209

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address3132 W ALTA VISTA RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850415209
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6238730204
The telephone number associated with the location address of the provider being identified.
NPI1588731970
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1385HR2055X
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
Provider Enumeration Date11/29/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)ROSLYN MOORE
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address3132 W ALTA VISTA RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850415209
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6238730204
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #1385HR2055X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Respite Care
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental illness, as respite for the regular caregivers.
Provider License Number 18559
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1917057
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1AZ
Other Provider Identifier State #1
Other Provider Identifier Issuer 1AHCCCS ID
Other Provider Identifier Issuer #1
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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