Healthcare Provider Details

I. General information

NPI: 1932961430
Provider Name (Legal Business Name): STARLIGHT COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 ALVIN AVE
SAN JOSE CA
95121-1609
US

IV. Provider business mailing address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

V. Phone/Fax

Practice location:
  • Phone: 408-270-6759
  • Fax:
Mailing address:
  • Phone: 408-270-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KENT DUNLAP
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential:
Phone: 310-221-6336