Rebecca Mae Forbes

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

AS030265913 Issued in MI

Legal business name

REBECCA MAE FORBES

Doing business as

Blue Moon House

Practice address

130 45TH St
Bloomingdale, MI 49026-9502

Phone

(269) 521-4500

NPI assigned

Feb 9, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Rebecca Mae Forbes

Title

Sole Proprietor

Phone

(269) 521-4500

Specialties & licenses 1

Addresses

Other names 1

• Blue Moon House Doing business as

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

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1467725234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 45TH ST",
            "city": "BLOOMINGDALE",
            "state": "MI",
            "postal_code": "490269502",
            "telephone_number": "269-521-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 45TH ST",
            "city": "BLOOMINGDALE",
            "state": "MI",
            "postal_code": "490269502",
            "telephone_number": "269-521-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBECCA MAE FORBES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "FORBES",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "269-521-4500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MI",
            "license": "AS030265913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Moon House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Bloomingdale, MI
• Providers in Bloomingdale, MI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.