Blue Moon Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BLUE MOON HOSPICE CARE INC

Practice address

13041 N 35TH Ave Ste C11-12
Phoenix, AZ 85029-1230

Phone

(928) 766-0902

Fax

(928) 766-4123

NPI assigned

Mar 31, 2022

Organization subpart

No

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

Authorized official

Name

Diana Shyshakova

Title

Ceo

Phone

(928) 766-0902

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1649910183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13041 N 35TH AVE STE C11-12",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291230",
            "telephone_number": "928-766-0902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13041 N 35TH AVE STE C11-12",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850291230",
            "telephone_number": "928-766-0902",
            "fax_number": "928-766-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MOON HOSPICE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-31",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "SHYSHAKOVA",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-766-0902"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.