Provider Demographics
NPI:1336737600
Name:MOONLIGHT HOME CARE LLC
Entity Type:Organization
Organization Name:MOONLIGHT HOME CARE LLC
Other - Org Name:MOONLIGHT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:MONOWARUL
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-253-5139
Mailing Address - Street 1:1075 EASTON AVENUE
Mailing Address - Street 2:TOWER 2, SUITE 7
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1686
Mailing Address - Country:US
Mailing Address - Phone:732-253-5139
Mailing Address - Fax:
Practice Address - Street 1:1075 EASTON AVENUE
Practice Address - Street 2:TOWER 2, SUITE 7
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1686
Practice Address - Country:US
Practice Address - Phone:732-253-5139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome HealthGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities