Healthcare Provider Details

I. General information

NPI: 1588489199
Provider Name (Legal Business Name): BRIGHTSTAR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 MOUNTAIN BLVD STE 106
WATCHUNG NJ
07069-6269
US

IV. Provider business mailing address

776 MOUNTAIN BLVD STE 106
WATCHUNG NJ
07069-6269
US

V. Phone/Fax

Practice location:
  • Phone: 732-501-7563
  • Fax:
Mailing address:
  • Phone: 732-501-7563
  • 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: JUSTIN K WILSON
Title or Position: VICE PRESIDENT
Credential: NURSE PRACTITIONER
Phone: 732-501-7563