Provider Demographics
NPI:1285370544
Name:STARLIGHT HEALTH CARE SERVICES LTD
Entity type:Organization
Organization Name:STARLIGHT HEALTH CARE SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:OMBASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-439-8665
Mailing Address - Street 1:17674 54TH CT NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4644
Mailing Address - Country:US
Mailing Address - Phone:763-439-8665
Mailing Address - Fax:
Practice Address - Street 1:17674 54TH CT NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55374-4644
Practice Address - Country:US
Practice Address - Phone:763-439-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care