Provider Demographics
NPI:1528682143
Name:STAR LIGHT LLC
Entity type:Organization
Organization Name:STAR LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:MARGARET TURNER
Authorized Official - Last Name:VRADENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-710-4411
Mailing Address - Street 1:122 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3950
Mailing Address - Country:US
Mailing Address - Phone:970-417-4812
Mailing Address - Fax:970-249-5098
Practice Address - Street 1:122 S PARK AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3950
Practice Address - Country:US
Practice Address - Phone:970-417-4812
Practice Address - Fax:970-249-5098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STAR LIGHT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health