NPIMap

Organization Active NPI

Moonlite, LLC

Doing business as FirstLight Home Care Pueblo

  • In Home Supportive Care Agency
  • Pueblo, CO
National Provider Identifier
1982094165
Registry record updated Jan 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
04V769 Issued in CO
Legal business name
MOONLITE, LLC
Doing business as
FirstLight Home Care Pueblo
Practice address
2099 W US Highway 50 Ste 110
Pueblo, CO 81008-1677
Phone
(719) 569-7685
Fax
(719) 582-1659
NPI assigned
Jan 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2015

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

Authorized official

Name
Warren Martinson
Title
Owner
Phone
(970) 209-5608

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X 04V769 CO Primary

Addresses

Primary practice location

2099 W US Highway 50 Ste 110
Pueblo, CO 81008-1677

Mailing address

2531 Columbine LN
Montrose, CO 81401-5650
Phone (970) 209-5608

Other names 1

  • FirstLight Home Care Pueblo Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dba Firstlight Home Care Pueblo2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2099 W US Highway 50
Ste 110
Pueblo, CO 81008
Phone (719) 404-0087

NPI Registry JSON

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": "1982094165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2531 COLUMBINE LN",
            "city": "MONTROSE",
            "state": "CO",
            "postal_code": "814015650",
            "telephone_number": "970-209-5608",
            "fax_number": "970-249-7163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2099 W US HIGHWAY 50 STE 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081677",
            "telephone_number": "719-569-7685",
            "fax_number": "719-582-1659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOONLITE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "MARTINSON",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-209-5608"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "CO",
            "license": "04V769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FirstLight Home Care Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • 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.