# MOONLIGHT GARDEN RESIDENTIAL CARE FACILITIES FOR ELDERLY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PHYSICAL THERAPY ON LINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194970376
- **Authorized official:** MOZHGAN MOJAB (CEO)
- **Authorized official phone:** (310) 621-4595

## Contact information

- **Practice address:** 3670 BARRY AVE, LOS ANGELES, CA 90066-3202
- **Practice address phone:** (310) 621-4595
- **Practice address fax:** (310) 390-3883
- **Mailing address:** 3670 BARRY AVE, LOS ANGELES, CA 90066-3202
- **Mailing address phone:** (310) 621-4595
- **Mailing address fax:** (310) 390-3883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | PT 19312 | CA | Yes |

## Other

- **Enumeration date:** 12/01/2008
- **Last updated:** 08/11/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | W18826 | MEDICARE PROVIDER NUMBER | CA |