Moonlight Support Services LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

MOONLIGHT SUPPORT SERVICES LLC

Practice address

3110 Old Hwy 8
206
Roseville, MN 55113-5511

Phone

(602) 323-4873

NPI assigned

Feb 19, 2020

Organization subpart

No

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

Authorized official

Name

Abdirazaq IbrahimNPI 1326505686

Title

Owner

Phone

(602) 323-4873

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abdirazaq Ibrahim

  • Home Health Agency
  • Minneapolis, MN
  • NPI 1326505686
  NPD Authorized official

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1164055026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5913 PLEASANT AVE STE 104",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554192357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 OLD HWY 8",
            "address_2": "206",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551135511",
            "telephone_number": "602-323-4873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "ABDIRAZAQ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-323-4873"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph A Molinaro
• Rebecca Moncrief, OT
• Cherie Monge, LAMFT
• Hailee Monk, MA, LMFT
• Megan Monson Munoz, LMFT
• Geoffrey Paul Moore, PTA
• Jessica Lee Moore, LICSW
• Sharlyn Moravec, FNP-BC
• Joseph Patrick Morcomb, LPCC
• Jason Morgan

• Adolescent and Children Mental Health Clinic/Center in Roseville, MN
• Providers in Roseville, MN by specialty
• Adolescent and Children Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.