MEDICARE: MOONRISE HEALTHCARE, 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1861105488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONRISE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	2625 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1205
Country	:	US
Telephone Number	:	562-434-0974
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1205
Country	:	US
Telephone Number	:	562-434-0974
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	12/28/2022

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