Provider Demographics
NPI:1285938357
Name:STARLIGHT MEDICAL LLC
Entity type:Organization
Organization Name:STARLIGHT MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CASTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-757-7771
Mailing Address - Street 1:1909 GRENACHE LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6770
Mailing Address - Country:US
Mailing Address - Phone:770-757-7771
Mailing Address - Fax:
Practice Address - Street 1:1909 GRENACHE LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6770
Practice Address - Country:US
Practice Address - Phone:770-757-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)