Provider Demographics
NPI:1235014911
Name:MOOR CARE RESIDENTIAL LIVING SERVICES
Entity type:Organization
Organization Name:MOOR CARE RESIDENTIAL LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA LOUISE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-364-2534
Mailing Address - Street 1:7240 BRAMELL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1053
Mailing Address - Country:US
Mailing Address - Phone:313-364-2534
Mailing Address - Fax:313-364-2534
Practice Address - Street 1:7240 BRAMELL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48239-1053
Practice Address - Country:US
Practice Address - Phone:313-364-2534
Practice Address - Fax:313-364-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-11
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health