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Organization
MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC
Active
Organization
MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC
Active
Other names
PHYSICAL THERAPY ON LINE
Organization subpart
No
Provider details
NPI number
Authorized official
MOZHGAN MOJAB (CEO)
(310) 621-4595
Entity
Organization
Contact information
Practice address
3670 BARRY AVE, LOS ANGELES, CA 90066-3202
(310) 621-4595
(310) 390-3883
Mailing address
3670 BARRY AVE, LOS ANGELES, CA 90066-3202
(310) 621-4595
(310) 390-3883
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
PT 19312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18826
MEDICARE PROVIDER NUMBER
CA
Enumeration date
12/01/2008
Last updated
08/11/2009
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