Provider Demographics
NPI:1215709019
Name:MOKSHA LIVING
Entity type:Organization
Organization Name:MOKSHA LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARICE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:YERKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:681-214-0025
Mailing Address - Street 1:14 E GRAFTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4465
Mailing Address - Country:US
Mailing Address - Phone:681-214-0025
Mailing Address - Fax:
Practice Address - Street 1:14 E GRAFTON RD STE A
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4465
Practice Address - Country:US
Practice Address - Phone:681-214-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty