Provider Demographics
NPI:1679342232
Name:MOON HOME CARE
Entity Type:Organization
Organization Name:MOON HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SHAMSU
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-996-8611
Mailing Address - Street 1:330 LYNNWAY UNIT 470H
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1706
Mailing Address - Country:US
Mailing Address - Phone:347-996-8611
Mailing Address - Fax:
Practice Address - Street 1:330 LYNNWAY UNIT 470H
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1706
Practice Address - Country:US
Practice Address - Phone:347-996-8611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care