MOONLIGHT SUPPORT SERVICES LLC


Address: 3110 Old Hwy 8, 206, Roseville, MN 55113-5511
Phone: 6023234873

MOONLIGHT SUPPORT SERVICES LLC (NPI# 1164055026) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164055026
Entity Type Organization
Organization Name MOONLIGHT SUPPORT SERVICES LLC
Practice Address 3110 Old Hwy 8
206
Roseville
MN 55113-5511
Mailing Address 5913 Pleasant Ave Ste 104
Minneapolis
MN 55419-2357
Practice Telephone 6023234873
Enumeration Date 2020-02-19
Last Update Date 2020-02-19
Authorized Official Name ABDIRAZAQ IBRAHIM (OWNER)
Authorized Official Telephone 6023234873
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM0855X Clinic/Center
Specialization: Adolescent and Children Mental Health
Ambulatory Health Care Facilities

Office Location

Street Address 3110 OLD HWY 8
206
City ROSEVILLE
State MN
Zip Code 55113-5511

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Taxonomy Information

Taxonomy Code 261QM0855X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Adolescent and Children Mental Health

Taxonomy Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1609412063 Gateway Residential Programs Clinic/Center 1780 Vernon St Ste 1, Roseville, CA 95678-6311 2019-11-20

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1821697202 Kids Zone Autism Center Inc Clinic/Center 670 Marigold Ter Ne, Fridley, MN 55432-5641 2020-10-18
1568079374 Midway Counseling Services LLC Clinic/Center 1410 9th Ave S Apt 306, Saint Cloud, MN 56301-5787 2020-09-25
1801409099 Star Autism Center Clinic/Center 3333 W Division St Ste 116, Saint Cloud, MN 56301-4548 2020-08-26
1851900484 Iron Range Behavioral Services LLC Clinic/Center 817 S 5th Ave, Virginia, MN 55792-2804 2020-07-29
1184240103 Adhd&u Clinic/Center 2196 Carter Ave, Saint Paul, MN 55108-1709 2020-06-25
1033744008 Star Health Services Clinic/Center 3055 Old High 8, Saint Anthony, MN 55418 2020-03-10
1659906071 Amoud Center Inc Clinic/Center 1925 Portland Ave, Minneapolis, MN 55404-2713 2020-03-05
1285279554 Metro Therapy Center Inc Clinic/Center 2520 Pillsbury Ave S Apt 306, Minneapolis, MN 55404-4208 2019-11-11
1710536081 Blu Care Inc Clinic/Center 2910 Pillsbury Ave S Ste 338, Minneapolis, MN 55408 2019-09-09
1568017374 The Bridge Autism Clinic LLC Clinic/Center 690 Cleveland Ave South, Suite 100, St Paul, MN 55116 2019-08-08
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Competitor

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City ROSEVILLE
Zip Code 55113

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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