Moonlight Home Healthcare Services, LLC

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

Legal business name

MOONLIGHT HOME HEALTHCARE SERVICES, LLC

Practice address

2800 Selkirk Dr Apt 310C
Burnsville, MN 55337-5676

Phone

(651) 347-3096

NPI assigned

Jan 27, 2015

Organization subpart

No

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

Authorized official

Name

Asad Salah Abdalle

Title

Administrator

Phone

(651) 347-3096

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1851781058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 SELKIRK DR APT 310C",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375676",
            "telephone_number": "651-347-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 SELKIRK DR APT 310C",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375676",
            "telephone_number": "651-347-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLIGHT HOME HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "ABDALLE",
        "authorized_official_first_name": "ASAD",
        "authorized_official_middle_name": "SALAH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-347-3096"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Administrator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "163WC0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalyana Tejasvi Mondreti, DDS
• Jenna Montgomery
• Alea Raquel Montoya
• Alyson Montplaisir, LICSW
• Mackenna Moon
• Colleen Moore
• Deborah Ann Moore, OTR/L, RN, CES
• Dominic Moore
• Jordan Marie Moore
• Michaun Moore

• Administrator Registered Nurse in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Administrator Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.