Healthcare Provider Details

I. General information

NPI: 1437652401
Provider Name (Legal Business Name): BRIGHTSTAR CRDM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 N PARK PL NE STE 202
CEDAR RAPIDS IA
52402-6235
US

IV. Provider business mailing address

1125 TRI STATE PKWY STE 700
GURNEE IL
60031-9177
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-2721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TODD HOUGHTON
Title or Position: DIRECTOR, CORPORATE LOCATIONS
Credential:
Phone: 813-361-5893