Provider Demographics
NPI:1982435855
Name:MORIAH HOME LLC
Entity type:Organization
Organization Name:MORIAH HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYIRAMUKOBWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-305-6450
Mailing Address - Street 1:6805 LEWIS CARROLL CT
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-4504
Mailing Address - Country:US
Mailing Address - Phone:515-305-6450
Mailing Address - Fax:
Practice Address - Street 1:6802 LEWIS CARROLL CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-4504
Practice Address - Country:US
Practice Address - Phone:515-305-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health