Provider Demographics
NPI:1851732564
Name:REDMOON PRIVATE CAREGIVERS AND CONSULTANTS
Entity Type:Organization
Organization Name:REDMOON PRIVATE CAREGIVERS AND CONSULTANTS
Other - Org Name:REDMOON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:607-254-6090
Mailing Address - Street 1:222 S ALBANY ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5471
Mailing Address - Country:US
Mailing Address - Phone:607-254-6090
Mailing Address - Fax:607-254-6091
Practice Address - Street 1:222 S ALBANY ST
Practice Address - Street 2:SUITE1
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5471
Practice Address - Country:US
Practice Address - Phone:607-254-6090
Practice Address - Fax:607-254-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1236L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health