Bluemoon Health Management

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

BLUEMOON HEALTH MANAGEMENT

Practice address

196 Buffalo Ave
Suite 3B
Brooklyn, NY 11213-3283

Phone

(585) 709-3388

NPI assigned

Dec 28, 2016

Last updated

Dec 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gwendolyn Knight

Title

Director/Owner

Phone

(585) 709-3388

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482883200000",
    "number": "1912442070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 BUFFALO AVE",
            "address_2": "APT 3B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112133282",
            "telephone_number": "585-709-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 BUFFALO AVE",
            "address_2": "SUITE 3B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112133283",
            "telephone_number": "585-709-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEMOON HEALTH MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "585-709-3388"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bluestar Dental Care

• Adult Care Home Facility in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Adult Care Home Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; 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.