=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235938036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RJ STARLIGHT HOME CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2025
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2680 BRYANT ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-250-1473
-----------------------------------------------------
Fax | 415-648-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 HUCKLEBERRY CT
-----------------------------------------------------
City | BRISBANE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94005-1264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-250-1473
-----------------------------------------------------
Fax | 415-648-2280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TERESITA JOMOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-250-1473
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------