Provider Demographics
NPI:1447634662
Name:MORIAH COOPERATIVE INC
Entity type:Organization
Organization Name:MORIAH COOPERATIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-779-9011
Mailing Address - Street 1:21001 N TATUM BLVD
Mailing Address - Street 2:SUITE 1630-233
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21001 N TATUM BLVD
Practice Address - Street 2:SUITE 1630-233
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4206
Practice Address - Country:US
Practice Address - Phone:480-779-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable