Moonlite, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MOONLITE, LLC

Doing business as

dba FirstLight Home Care Pueblo

Practice address

805 Eagleridge Blvd Ste 120
Pueblo, CO 81008-2354

Phone

(970) 209-0223

NPI assigned

Jun 9, 2015

Organization subpart

No

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

Authorized official

Name

Judy Devincentis

Title

Member

Phone

(970) 209-0223

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• dba FirstLight Home Care Pueblo Doing business as

Tax ID family

Dba Firstlight Home Care Pueblo2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Moonlite, LLC

  dba FirstLight Home Care Pueblo

  • In Home Supportive Care Agency
  • Pueblo, CO
  • NPI 1982094165
  NPD tax ID

Locations

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

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1104207760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 EAGLERIDGE BLVD STE 120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082354",
            "telephone_number": "970-209-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 EAGLERIDGE BLVD STE 120",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082354",
            "telephone_number": "970-209-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLITE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "DEVINCENTIS",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "970-209-0223"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "76356523",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba FirstLight Home Care Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Josiah Montoya, BA, PEER SPECIALIST
• Lindsey Michelle Montoya, PHARMD
• Mark Montoya, R.PH
• Raymond Anthony Montoya
• Savannah Montoya, COTA/L
• Moonlite, LLC (FirstLight Home Care Pueblo)
• Avie B. Moore, COTA
• Betty Moore
• Deborah Jane Moore, RN
• Janice Renee Moore

• Home Health Agency in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Home Health Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.