Healthcare Provider Details

I. General information

NPI: 1770285702
Provider Name (Legal Business Name): STARLIGHT FACILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7647 TUJUNGA AVE
NORTH HOLLYWOOD CA
91605-2937
US

IV. Provider business mailing address

7647 TUJUNGA AVE
NORTH HOLLYWOOD CA
91605-2937
US

V. Phone/Fax

Practice location:
  • Phone: 818-378-7069
  • Fax:
Mailing address:
  • Phone: 818-378-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NELLI TADEVOSYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 818-378-7069