=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457618779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARLIGHT HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2012
-----------------------------------------------------
Last Update Date | 04/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2642 12TH ST NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20018-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-269-1619
-----------------------------------------------------
Fax | 202-683-6739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12656 HEMING LN
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20716-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-269-1619
-----------------------------------------------------
Fax | 202-683-6739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. DANILEL ZINKENG ASONGANYI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-378-3973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | NSA-0188
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------