=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417293713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTSTAR ESCONDIDO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2012
-----------------------------------------------------
Last Update Date | 12/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 639 N ESCONDIDO BLVD
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-738-1926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 639 N ESCONDIDO BLVD
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-1701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | TRACY KAISER
-----------------------------------------------------
Credential | R.N.
-----------------------------------------------------
Telephone | 760-738-1926
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 620821
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------