Provider Demographics
NPI:1346711686
Name:BLUE MOON HOME HEALTH. INC.
Entity Type:Organization
Organization Name:BLUE MOON HOME HEALTH. INC.
Other - Org Name:BLUE MOON HOME HEALTH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YERVAND
Authorized Official - Middle Name:
Authorized Official - Last Name:YEGOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-817-9040
Mailing Address - Street 1:260 S. LOS ROBLES AVE.
Mailing Address - Street 2:SUITE 114
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2869
Mailing Address - Country:US
Mailing Address - Phone:626-817-9040
Mailing Address - Fax:626-817-9139
Practice Address - Street 1:260 S. LOS ROBLES AVE.
Practice Address - Street 2:SUITE 114
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2869
Practice Address - Country:US
Practice Address - Phone:626-817-9040
Practice Address - Fax:626-817-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health