| Moore Lifestyle Llc | |
|
1808 61st Ave Cheverly MD 20785-3803 | |
| (240) 319-0182 | |
| (240) 319-0182 |
| Full Name | Moore Lifestyle Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1808 61st Ave, Cheverly, Maryland |
| Authorized Official Name and Position | Demarest Crawl (OWNER) |
| Authorized Official Contact | 2403190182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moore Lifestyle Llc 1808 61st Ave Cheverly MD 20785-3803 Ph: (240) 319-0182 | Moore Lifestyle Llc 1808 61st Ave Cheverly MD 20785-3803 Ph: (240) 319-0182 |
| NPI Number | 1518512649 |
|---|---|
| Provider Enumeration Date | 08/06/2019 |
| Last Update Date | 08/06/2019 |
| Medicare PECOS PAC ID | 0446686315 |
|---|---|
| Medicare Enrollment ID | O20200213000096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518512649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Demarest Crawl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023663325 PECOS PAC ID: 5991131864 Enrollment ID: I20200213000154 |
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