Provider Demographics
NPI:1003058835
Name:MOONLITE HOME CARE INC
Entity type:Organization
Organization Name:MOONLITE HOME CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAHIR
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOUSAFZAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-354-4215
Mailing Address - Street 1:31153 PLYMOUTH RD
Mailing Address - Street 2:106
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2134
Mailing Address - Country:US
Mailing Address - Phone:313-354-4215
Mailing Address - Fax:734-448-1649
Practice Address - Street 1:31153 PLYMOUTH RD
Practice Address - Street 2:106
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2134
Practice Address - Country:US
Practice Address - Phone:313-354-4215
Practice Address - Fax:734-448-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health