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General NPI Number Information
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NPI Number | 1528682143
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Entity Type | Organization
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Legal Business Name | STAR LIGHT LLC
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 122 S PARK AVE
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City | MONTROSE
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State | CO
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Zip | 81401-3950
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Country | US
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Telephone | 970-417-4812
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Fax | 970-249-5098
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Provider Business Mailing Address
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Address Line | 122 S PARK AVE
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City | MONTROSE
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State | CO
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Zip | 81401-3950
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Country | US
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Telephone | 970-417-4812
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Fax | 970-249-5098
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Authorized Official
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Title or Position | REGIONAL BUSINESS DIRECTOR
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Name | KITTY MARGARET TURNER VRADENBURG
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Credential | DO
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Telephone | 602-710-4411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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