Organization Active NPI

Moonlight Home Health Care Inc

  • Home Health Agency
  • Youngstown, OH
National Provider Identifier
1083984769
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
2017084 Issued in OH
Legal business name
MOONLIGHT HOME HEALTH CARE INC
Practice address
102 Javit CT
Youngstown, OH 44515-2409
Phone
(330) 990-0960
Fax
(614) 396-7411
NPI assigned
Jan 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sasi Kaza
Title
Owner
Phone
(330) 990-0960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 2017084 OH Primary

Addresses

Primary practice location

102 Javit CT
Youngstown, OH 44515-2409

Mailing address

5900 Roche Dr Ste 227
Columbus, OH 43229-3273
Phone (614) 396-7345

Other practice location 1

5900 Roche Dr Ste 227
Columbus, OH 43229-3273
Phone (614) 396-7345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120710000651 OH Part A Provider - Home Health Agency 3072778463 Practice locations: Youngstown, OH

Home health agency certification: CCN 369006

Legal name
MOONLIGHT HOME HEALTH CARE INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 19, 2013
Last certification
Feb 6, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Apr 28, 2011 in OH
Enrollment address
102 Javit Court
Youngstown, OH 44515
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Moonlight Home Health Care IncCCN 369006
Ownership
Proprietary
Certified
Apr 19, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

113 S Court St
Ste 230
Circleville, OH 43113
Phone (614) 396-7345

5900 Roche Dr
Ste 227
Columbus, OH 43229
Phone (614) 396-6360

1971 W 5th Ave
Ste 3
Columbus, OH 43212
Phone (614) 481-1937

117 W Main St
Ste 202
Lancaster, OH 43130
Phone (614) 396-7345

102 Javit Ct
Youngstown, OH 44515
Phone (330) 990-0960

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Abdirahman Abdullah Individual W-2 Managing Employee Dec 6, 2019
Sasi Kaza Individual 5% Or Greater Direct Ownership Interest Dec 6, 2019 100%
Dana Meek Individual Corporate Officer Jul 22, 2020

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1083984769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 ROCHE DR STE 227",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432293273",
            "telephone_number": "614-396-7345",
            "fax_number": "614-396-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 JAVIT CT",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445152409",
            "telephone_number": "330-990-0960",
            "fax_number": "614-396-7411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 Roche Dr Ste 227",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432293273",
            "country_code": "US",
            "telephone_number": "614-396-7345",
            "fax_number": "614-396-7411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MOONLIGHT HOME HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-11",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A",
        "authorized_official_last_name": "KAZA",
        "authorized_official_first_name": "SASI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "330-990-0960"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": "2017084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

Verify at the official NPI Registry.