Healthcare Provider Details

I. General information

NPI: 1306514526
Provider Name (Legal Business Name): MOONHILL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 309-G5
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR STE 309G
BEVERLY MA
01915-6107
US

V. Phone/Fax

Practice location:
  • Phone: 781-346-5691
  • Fax:
Mailing address:
  • Phone: 781-346-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. GERARD YOYO NGUEJIP YANKAM
Title or Position: CEO
Credential: LPN
Phone: 781-417-0790