Healthcare Provider Details

I. General information

NPI: 1669389920
Provider Name (Legal Business Name): MOONLIGHT TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9018 FORT ST
OMAHA NE
68134-1749
US

IV. Provider business mailing address

9018 FORT ST
OMAHA NE
68134-1749
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-5616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KUMAR GURUNG
Title or Position: CEO
Credential:
Phone: 402-812-5616