Healthcare Provider Details

I. General information

NPI: 1255260105
Provider Name (Legal Business Name): MOONLIT ACRES RETREAT FARM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 BARK HILL RD
UNION BRIDGE MD
21791-9224
US

IV. Provider business mailing address

3910 BARK HILL RD
UNION BRIDGE MD
21791-9224
US

V. Phone/Fax

Practice location:
  • Phone: 410-707-7501
  • Fax: 410-707-7501
Mailing address:
  • Phone: 410-707-7501
  • Fax: 410-707-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HOLLY BONNEY
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential:
Phone: 410-707-7501