Provider Demographics
NPI: | 1104565126 |
---|---|
Name: | MOTO HEALTH CORP |
Entity type: | Organization |
Organization Name: | MOTO HEALTH CORP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GUILIT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NSEKA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 347-567-2036 |
Mailing Address - Street 1: | 18608 E VASSAR DR |
Mailing Address - Street 2: | |
Mailing Address - City: | AURORA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80013-6467 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 720-341-6689 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 18608 E VASSAR DR |
Practice Address - Street 2: | |
Practice Address - City: | AURORA |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80013-6467 |
Practice Address - Country: | US |
Practice Address - Phone: | 720-341-6689 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-05-27 |
Last Update Date: | 2022-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |