| NPI | 1124842687 |
|---|---|
| Former Legal Business Name | MOONLIGHT CONVALESCENCE CARE LLC |
| Doing Business As | MOONLIGHT CONVALESCENCE CARE LLC |
| Entity Type | Organization |
| Authorized Contact | WAHAB OLAIYA ALABI Co Owner 971-348-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-12 |