Provider Demographics
NPI:1922245844
Name:MOONLIGHT HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:MOONLIGHT HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIACHITEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-405-4668
Mailing Address - Street 1:3729 TOWNE CROSSING BLVD APT 1914
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2735
Mailing Address - Country:US
Mailing Address - Phone:214-405-4668
Mailing Address - Fax:214-696-9863
Practice Address - Street 1:3729 TOWNE CROSSING BLVD APT 1914
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2735
Practice Address - Country:US
Practice Address - Phone:214-405-4668
Practice Address - Fax:214-696-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health