Provider Demographics
NPI:1851781058
Name:MOONLIGHT HOME HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:MOONLIGHT HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:SALAH
Authorized Official - Last Name:ABDALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-347-3096
Mailing Address - Street 1:2800 SELKIRK DR APT 310C
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5676
Mailing Address - Country:US
Mailing Address - Phone:651-347-3096
Mailing Address - Fax:
Practice Address - Street 1:2800 SELKIRK DR APT 310C
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-5676
Practice Address - Country:US
Practice Address - Phone:651-347-3096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty