# REBECCA MAE FORBES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Moon House
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467725234
- **Authorized official:** MS. REBECCA MAE FORBES (SOLE PROPRIETOR)
- **Authorized official phone:** (269) 521-4500

## Contact information

- **Practice address:** 130 45TH ST, BLOOMINGDALE, MI 49026-9502
- **Practice address phone:** (269) 521-4500
- **Mailing address:** 130 45TH ST, BLOOMINGDALE, MI 49026-9502
- **Mailing address phone:** (269) 521-4500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | AS030265913 | MI | Yes |

## Other

- **Enumeration date:** 02/09/2012
- **Last updated:** 02/09/2012