Provider Demographics
NPI:1962116939
Name:MORNINGSTAR SENIOR LIVING LLC
Entity type:Organization
Organization Name:MORNINGSTAR SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOICU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-920-9598
Mailing Address - Street 1:3400 83RD ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1042
Mailing Address - Country:US
Mailing Address - Phone:360-920-9598
Mailing Address - Fax:
Practice Address - Street 1:3450 DULUTH PARK LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3257
Practice Address - Country:US
Practice Address - Phone:770-558-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility