Provider Demographics
NPI:1538282439
Name:THE MOOREHOUSE GROUP, INC.
Entity type:Organization
Organization Name:THE MOOREHOUSE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEDDY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:MOOREHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAP, ICADC, SAP
Authorized Official - Phone:904-981-9881
Mailing Address - Street 1:1727 BLANDING BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1962
Mailing Address - Country:US
Mailing Address - Phone:904-981-9881
Mailing Address - Fax:904-981-9883
Practice Address - Street 1:1727 BLANDING BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1962
Practice Address - Country:US
Practice Address - Phone:904-981-9881
Practice Address - Fax:904-981-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health