Provider Demographics
NPI:1154581858
Name:STARLIGHT HEALTH SERVICES LLC
Entity type:Organization
Organization Name:STARLIGHT HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ZINKENG
Authorized Official - Last Name:ASONGANYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-782-0094
Mailing Address - Street 1:12656 HEMING LANE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716
Mailing Address - Country:US
Mailing Address - Phone:240-782-0094
Mailing Address - Fax:
Practice Address - Street 1:12656 HEMING LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1119
Practice Address - Country:US
Practice Address - Phone:240-782-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0001565399OtherWORK ORDER NUMBER
MD0002122361OtherCOSTUMER ID
MD1000361996307827OtherFILLING NUMBER
MDW12497004OtherDEPARTMENT ID