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General NPI Number Information
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NPI Number | 1154581858
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Entity Type | Organization
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Legal Business Name | STARLIGHT HEALTH SERVICES LLC
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 12656 HEMING LN
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City | BOWIE
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State | MD
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Zip | 20716-1119
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Country | US
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Telephone | 240-782-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 12656 HEMING LANE
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City | BOWIE
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State | MD
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Zip | 20716
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Country | US
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Telephone | 240-782-0094
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. DANIEL ZINKENG ASONGANYI
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Credential |
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Telephone | 240-782-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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