MEDICARE: MOONLITE HOME CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003058835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONLITE HOME CARE INC

Provider Business Mailing Address
First Line	:	31153 PLYMOUTH RD
Second Line	:	106
City	:	LIVONIA
State	:	MI
Zip	:	48150-2134
Country	:	US
Telephone Number	:	313-354-4215
Fax Number	:	734-448-1649

Provider Business Practice Location Address
First Line	:	31153 PLYMOUTH RD
Second Line	:	106
City	:	LIVONIA
State	:	MI
Zip	:	48150-2134
Country	:	US
Telephone Number	:	313-354-4215
Fax Number	:	734-448-1649

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MR. ZAHIR B YOUSAFZAI
Credential	:
Telephone Number	:	313-354-4215

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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