Moonlight Garden Residential Care Facilities for Elderly Inc

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

PT 19312 Issued in CA

Legal business name

MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC

Practice address

3670 Barry Ave
Los Angeles, CA 90066-3202

Phone

(310) 621-4595

Fax

(310) 390-3883

NPI assigned

Dec 1, 2008

Organization subpart

No

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

Authorized official

Name

Mozhgan Mojab

Title

Ceo

Phone

(310) 621-4595

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PHYSICAL THERAPY ON LINE Doing business as

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

{
    "created_epoch": "1228089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249948800000",
    "number": "1194970376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 BARRY AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900663202",
            "telephone_number": "310-621-4595",
            "fax_number": "310-390-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 BARRY AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900663202",
            "telephone_number": "310-621-4595",
            "fax_number": "310-390-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-01",
        "last_updated": "2009-08-11",
        "status": "A",
        "authorized_official_last_name": "MOJAB",
        "authorized_official_first_name": "MOZHGAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-621-4595"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "CA",
            "license": "PT 19312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "W18826",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHYSICAL THERAPY ON LINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elissa Mooney Taylor, OTR/L
• Allyson Denise Mooney, PTA
• Bailey Mooney, MD
• Grace Hillary Ann Mooney, NP
• Larissa Jeanette Mooney, M.D.
• Moor Out of Life
• Lesley Moorcroft, L.AC
• Angela Moore-Hodge
• Tumani S. Moore-Leatherwood, MD
• Ayesha Moore-Muhammad

• Case Management Agency in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Case Management Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2009; 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.