Provider Demographics
NPI:1073206033
Name:MOONLIGHT HOME HEALTH SERVERCES LLC
Entity Type:Organization
Organization Name:MOONLIGHT HOME HEALTH SERVERCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FEISAL
Authorized Official - Middle Name:ALIYOW
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-632-2165
Mailing Address - Street 1:1420 RICHMOND RD APT M1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2433
Mailing Address - Country:US
Mailing Address - Phone:614-632-2165
Mailing Address - Fax:
Practice Address - Street 1:1420 RICHMOND RD APT M1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-2433
Practice Address - Country:US
Practice Address - Phone:614-632-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health