Healthcare Provider Details

I. General information

NPI: 1629516729
Provider Name (Legal Business Name): STARBRIGHT PEDIATRIC HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRONCO CT
PERALTA NM
87042-8508
US

IV. Provider business mailing address

10 BRONCO CT
PERALTA NM
87042-8508
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-0550
  • Fax:
Mailing address:
  • Phone: 505-681-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STARR ALEXANDRA TAYS
Title or Position: OWNER
Credential: RN
Phone: 505-681-0550