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General NPI Number Information
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NPI Number | 1619211067
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Entity Type | Organization
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Legal Business Name | STARLIGHT ADULT DAY CARE
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Dates
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Enumeration Date | 11/23/2012
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Last Update Date | 11/23/2012
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Provider Practice Location Address
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Address Line | 818 CHADDICK DR
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City | WHEELING
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State | IL
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Zip | 60090-6450
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Country | US
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Telephone | 847-229-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 818 CHADDICK DR
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City | WHEELING
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State | IL
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Zip | 60090-6450
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Country | US
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Telephone | 847-229-0001
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | ERNST BERLIN
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Credential |
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Telephone | 847-673-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ADS1112003
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ADS1113003
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License Number State | IL
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