Organization
MOONSTAR BEHAVIORAL HME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDI BASHIR DOL (OWNER)
(623) 688-4946
Entity
Organization
Contact information
Practice address
5121 W SAN GABRIEL AVE, LAVEEN, AZ 85339-5410
(623) 688-4946
Mailing address
5121 W SAN GABRIEL AVE, LAVEEN, AZ 85339-5410
(623) 688-4946
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
Other
Enumeration date
04/30/2022
Last updated
04/30/2022
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