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MOONLIGHT SUPPORT SERVICES LLC
NPI 1164055026
Clinic/Center - Adolescent and Children Mental Health in Roseville, MN

Active since February 19, 2020
3110 OLD HWY 8, 206, ROSEVILLE, MN 55113(602) 323-4873 Get Directions Write a Review

NPPES record last updated: February 19, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Moonlight Support Services Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOONLIGHT SUPPORT SERVICES LLC (NPI 1164055026) is a healthcare organization registered as an adolescent and children mental health in Roseville, Minnesota and active in the NPI registry since February 2020. The organization lists Abdirazaq Ibrahim, Owner, as its authorized official.

NPPES Registry Identity

NPI1164055026
Entity TypeOrganization
Primary Taxonomy261QM0855X
Legal Business NameMOONLIGHT SUPPORT SERVICES LLC
Location Address3110 OLD HWY 8, 206Roseville, MN 55113-5511
Mailing Address5913 Pleasant Ave Ste 104Minneapolis, MN 55419-2357
Phone(602) 323-4873
Organization SubpartNo
Authorized OfficialAbdirazaq IbrahimOwner · (602) 323-4873
Enumeration DateFebruary 19, 2020
✔ NPI 1164055026 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adolescent and Children Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0855X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
3110 OLD HWY 8, Roseville, MN 55113
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moonlight Support Services LLC's NPI number?

The NPI number for Moonlight Support Services LLC is 1164055026. It was assigned to this organization in the NPPES registry on February 19, 2020.

Where is Moonlight Support Services LLC located?

Moonlight Support Services LLC is located at 3110 Old Hwy 8 206, Roseville, MN 55113. The listed phone number is (602) 323-4873.

What is Moonlight Support Services LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

When was this NPI record last updated?

The NPPES record for Moonlight Support Services LLC was last updated on February 19, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.