BLUE MOON HOUSE
NPI 1467725234
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Bloomingdale, MI
- Organization
- Residential Treatment Facility, Intellec...
About BLUE MOON HOUSE
This page provides the complete NPI Profile along with additional information for Blue Moon House, a provider established in Bloomingdale, Michigan operating as a Residential Treatment Facility, Intellectual And/or Developmental Disabilities. The healthcare provider is registered in the NPI registry with number 1467725234 assigned on February 2012. The practitioner's primary taxonomy code is 320600000X with license number AS030265913 (MI). The provider is registered as an organization and their NPI record was last updated 14 years ago. The provider's is doing business as Blue Moon House. The authorized official of this NPI record is Ms. Rebecca Mae Forbes (Sole Proprietor)
- NPI
- 1467725234 Verify this NPI
- Provider Legal Name
- REBECCA MAE FORBES
- Other Organization Name
- BLUE MOON HOUSE
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 130 45TH ST BLOOMINGDALE, MI 49026
- Location Phone
- (269) 521-4500
- Mailing Address
- 130 45TH ST BLOOMINGDALE, MI 49026
- Mailing Phone
- (269) 521-4500
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-09-2012
- Last Update Date
- 02-09-2012
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Taxonomy Code
- 320600000X
- Type
- Residential Treatment Facilities
- License No.
- AS030265913
- License State
- MI
- Taxonomy Description
- A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1467725234, enumerated as an "organization" on February 09, 2012.
The provider is located at 130 45TH ST BLOOMINGDALE, MI 49026 and the phone number is (269) 521-4500.
Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.
