Blue Moon Home Health. Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

BLUE MOON HOME HEALTH. INC.

Practice address

260 S. Los Robles Ave.
Suite 114
Pasadena, CA 91101-2869

Phone

(626) 817-9040

Fax

(626) 817-9139

NPI assigned

Dec 16, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Yervand Yegoyan

Title

Ceo

Phone

(626) 817-9040

Specialties & licenses 1

Addresses

Other names 1

• Blue Moon Home Health, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 757625

Legal name

BLUE MOON HOME HEALTH INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 3, 2024

Last certification

Jun 26, 2024

Organization structure

CorporationProprietary

Incorporated

Sep 28, 2018 in CA

Enrollment address

260 South Los Robles
Ste 114
Pasadena, CA 91101-2869

Listed as

Blue Moon Home Health, Inc.CCN 757625

Overall star rating

2 of 5

Ownership

-

Certified

Jul 3, 2024

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Desirae Mutuc, FNP-C

  • Family Nurse Practitioner
  • Laguna Hills, CA
  • NPI 1215393384

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership

Practitioners 1

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

• Desirae Mutuc, FNP-C

  • Family Nurse Practitioner
  • Laguna Hills, CA
  • NPI 1215393384
  NPD

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1346711686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 S. LOS ROBLES AVE.",
            "address_2": "SUITE 114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012869",
            "telephone_number": "626-817-9040",
            "fax_number": "626-817-9139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 S. LOS ROBLES AVE.",
            "address_2": "SUITE 114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012869",
            "telephone_number": "626-817-9040",
            "fax_number": "626-817-9139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MOON HOME HEALTH. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "YEGOYAN",
        "authorized_official_first_name": "YERVAND",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-817-9040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Moon Home Health, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Moon Home Health, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elisse A Blinder, PH.D.
• Kate Blissmer
• James Peter Blitz, MD
• Alfred M Bloch, MD
• Blossom Home Health Care Services Inc
• Blue River Hospice Inc
• Barry Blum, MD
• Lisa Caren Blum, PSY.D.
• Mindy J. Blum, PH.D.
• Stacey Blum

• Home Health Agency in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.