Provider Demographics
NPI:1588489199
Name:BRIGHTSTAR HOME CARE LLC
Entity type:Organization
Organization Name:BRIGHTSTAR HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:732-501-7563
Mailing Address - Street 1:776 MOUNTAIN BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6269
Mailing Address - Country:US
Mailing Address - Phone:732-501-7563
Mailing Address - Fax:
Practice Address - Street 1:776 MOUNTAIN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6269
Practice Address - Country:US
Practice Address - Phone:732-501-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care