MEDICARE: BRIGHT STAR RESIDENTIAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1255202354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT STAR RESIDENTIAL CARE LLC

Provider Business Mailing Address
First Line	:	3108 S 92ND DR
Second Line	:
City	:	TOLLESON
State	:	AZ
Zip	:	85353-5541
Country	:	US
Telephone Number	:	806-341-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	6932 W BEATRICE ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-2397
Country	:	US
Telephone Number	:	806-341-8658
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TENEMA MASSAQUOI
Credential	:	OWNER
Telephone Number	:	480-708-8512

Provider Enumeration Date	:	09/13/2025
Last Update Date	:	09/15/2025

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