Provider Demographics
NPI:1083984769
Name:MOONLIGHT HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:MOONLIGHT HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:WARSAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-596-3838
Mailing Address - Street 1:5900 ROCHE DR STE 227
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3273
Mailing Address - Country:US
Mailing Address - Phone:614-396-7345
Mailing Address - Fax:614-396-7411
Practice Address - Street 1:5900 ROCHE DR STE 227
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3273
Practice Address - Country:US
Practice Address - Phone:614-396-7345
Practice Address - Fax:614-396-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017084251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health