Provider Demographics
NPI:1215638853
Name:STARLIGHT CARE LLC
Entity type:Organization
Organization Name:STARLIGHT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EYOBE
Authorized Official - Middle Name:DEBEBE
Authorized Official - Last Name:WOLDEMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-500-7790
Mailing Address - Street 1:7632 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2842
Mailing Address - Country:US
Mailing Address - Phone:651-500-7790
Mailing Address - Fax:
Practice Address - Street 1:7632 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2842
Practice Address - Country:US
Practice Address - Phone:651-500-7790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency