Provider Demographics
NPI:1396022695
Name:MOONSTONE INC
Entity Type:Organization
Organization Name:MOONSTONE INC
Other - Org Name:BLESSED EDGE AFC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-685-8329
Mailing Address - Street 1:377 N MAIN ST
Mailing Address - Street 2:PO BOX 377
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1368
Mailing Address - Country:US
Mailing Address - Phone:269-685-8329
Mailing Address - Fax:
Practice Address - Street 1:377 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1368
Practice Address - Country:US
Practice Address - Phone:269-685-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF030093563385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care