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General NPI Number Information
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NPI Number | 1194970376
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Entity Type | Organization
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Legal Business Name | MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 3670 BARRY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-3202
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Country | US
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Telephone | 310-621-4595
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Fax | 310-390-3883
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Provider Business Mailing Address
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Address Line | 3670 BARRY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90066-3202
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Country | US
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Telephone | 310-621-4595
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Fax | 310-390-3883
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Authorized Official
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Title or Position | CEO
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Name | MOZHGAN MOJAB
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Credential |
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Telephone | 310-621-4595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | PT 19312
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License Number State | CA
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