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Tavarius Jerrell Moore
Adult Care Home Facility in Burlington, North Carolina
NPI 1104384262

Tavarius Jerrell Moore is an Adult Care Home Facility based in Burlington, NC and is specialized in Adult Care Home. Tavarius Jerrell Moore practices in Burlington, NC. The NPI Number for Tavarius Jerrell Moore is 1104384262 and holds a License No. FCL-001-107 (North Carolina).

The current practice location address for Tavarius Jerrell Moore is 206 Friendly Rd, Burlington, NC and can be reached out via phone at 804-624-3515.

Location: 206 Friendly Rd, Burlington, NC, 27217-2502
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1104384262
Provider Name
Tavarius Jerrell Moore
Credential
Provider Entity Type
Individual
Gender
Male
Address
206 Friendly Rd, Burlington, NC, 27217-2502
Phone Number
804-624-3515
Fax Number
Provider Enumeration Date
03/07/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
206 Friendly Rd
City
Burlington
State
North Carolina
Zip
27217-2502
Phone Number
804-624-3515
Fax Number
person
Provider Business Mailing Address Details
Address
206 Friendly Rd
City
Burlington
State
North Carolina
Zip
27217-2502
Phone Number
804-624-3515
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
FCL-001-107 (North Carolina)
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
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