Provider Demographics
NPI:1861229668
Name:MOONRIZE HOME HEALTH SERVICES
Entity type:Organization
Organization Name:MOONRIZE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-585-9305
Mailing Address - Street 1:9778 KATELLA AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6446
Mailing Address - Country:US
Mailing Address - Phone:714-585-9305
Mailing Address - Fax:
Practice Address - Street 1:9778 KATELLA AVE STE 114
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6446
Practice Address - Country:US
Practice Address - Phone:714-585-9305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health