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1104384262
TAVARIUS JERRELL MOORE
BURLINGTON, NC
NPI
1104384262
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
311ZA0620X Custodial Care Facility Adult Care Home
(Licence: NC FCL-001-107)
Enumeration Date
2019-03-07
Last Update Date
2019-03-07
Business Address
TAVARIUS JERRELL MOORE
206 FRIENDLY RD
BURLINGTON, NC 27217-2502
Phone number: 804-624-3515
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Mailing Address
TAVARIUS JERRELL MOORE
206 FRIENDLY RD
BURLINGTON, NC 27217-2502
Phone number: 804-624-3515
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