# BLUEMOON HEALTH MANAGEMENT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912442070
- **Authorized official:** GWENDOLYN KNIGHT (DIRECTOR/OWNER)
- **Authorized official phone:** (585) 709-3388

## Contact information

- **Practice address:** 196 BUFFALO AVE, SUITE 3B, BROOKLYN, NY 11213-3283
- **Practice address phone:** (585) 709-3388
- **Mailing address:** 196 BUFFALO AVE, APT 3B, BROOKLYN, NY 11213-3282
- **Mailing address phone:** (585) 709-3388

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 12/28/2016
- **Last updated:** 12/28/2016