Organization
MOONLIGHT GROUP HOMES LLC
Active
Other names
MOONLIGHT GROUP HOMES LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KHASIN ABDISALAN SABAN (CEO)
(207) 241-7299
Entity
Organization
Contact information
Practice address
253 LISBON STREET, LEWISTON, ME 04240-7704
(207) 344-4165
Mailing address
253 LISBON STREET, LEWISTON, ME 04240-7704
(207) 344-4165
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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