Provider Demographics
NPI:1043033459
Name:MOORE, CHANELL RENEE
Entity type:Individual
Prefix:
First Name:CHANELL
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANEL
Other - Middle Name:RENEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1674 MAXEN DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1031
Mailing Address - Country:US
Mailing Address - Phone:330-234-1307
Mailing Address - Fax:
Practice Address - Street 1:1674 MAXEN DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1031
Practice Address - Country:US
Practice Address - Phone:330-234-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 253Z00000X, 385H00000X
OH3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant