Provider Demographics
NPI:1548508534
Name:MOSS, DELILAH MELONIE (CNA)
Entity type:Individual
Prefix:
First Name:DELILAH
Middle Name:MELONIE
Last Name:MOSS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125
Mailing Address - Country:US
Mailing Address - Phone:614-432-1939
Mailing Address - Fax:614-567-7014
Practice Address - Street 1:3850 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9457
Practice Address - Country:US
Practice Address - Phone:614-432-1939
Practice Address - Fax:614-567-7014
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 374U00000X, 376J00000X
OH379127640700376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker