OrganizationActive
Moonlight Support Services LLC
NPI 1164055026 · Adolescent and Children Mental Health Clinic/Center · Roseville, MN
Provider details
- NPI number
- 1164055026
- Entity type
- Organization
- Primary specialty
- Adolescent and Children Mental Health Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Abdirazaq Ibrahim, Owner(602) 323-4873
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(64/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3110 Old Hwy 8
206
Roseville, MN 55113-5511
Phone: (602) 323-4873
Street-level locationGet directions
Mailing address
5913 Pleasant Ave Ste 104
Minneapolis, MN 55419-2357
Registry dates
- Enumerated
- 2020-02-19
- Last updated
- 2020-02-19
- Certified
- 2020-02-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.