Healthcare Provider Details

I. General information

NPI: 1235851767
Provider Name (Legal Business Name): BRIGHTSTAR ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/27/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 SW MERIDIAN AVE
PORT SAINT LUCIE FL
34953-4300
US

IV. Provider business mailing address

1613 SW MERIDIAN AVE
PORT SAINT LUCIE FL
34953-4300
US

V. Phone/Fax

Practice location:
  • Phone: 954-864-9098
  • Fax: 772-807-1866
Mailing address:
  • Phone: 954-864-9098
  • Fax: 772-807-1866

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 Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: GERMINE LORMERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-864-9098