- Enrollment id
- O20180613000016
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1952751349
- Multiple npi flag
- N
- Ccn
- 559361
- Associate id
- 4981959152
- Organization name
- MOONLIGHT HOME HEALTHCARE, INC
- Incorporation date
- 2016-05-02
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 348 E OLIVE AVE
- Address line 2
- STE K
- City
- BURBANK
- State
- CA
- Zip code
- 915021250