Healthcare Provider Details

I. General information

NPI: 1871127902
Provider Name (Legal Business Name): STAR LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 INDEPENDENT AVE STE A119
GRAND JUNCTION CO
81505-6175
US

IV. Provider business mailing address

1048 INDEPENDENT AVE STE A119
GRAND JUNCTION CO
81505-6175
US

V. Phone/Fax

Practice location:
  • Phone: 970-639-2048
  • Fax: 970-639-2264
Mailing address:
  • Phone: 970-639-2048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI L HENDERSON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 970-275-4101