MEDICARE: BRIGHTSTARS HELPING HANDS 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295302727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSTARS HELPING HANDS LLC

Provider Business Mailing Address
First Line	:	3780 CLYDE MORRIS BLVD APT 1408
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-8993
Country	:	US
Telephone Number	:	386-265-4828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 CLYDE MORRIS BLVD APT 1408
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-8993
Country	:	US
Telephone Number	:	386-265-4828
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNTAE GORDON
Credential	:
Telephone Number	:	386-265-4828

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	11/28/2021

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Directions to “BRIGHTSTARS HELPING HANDS LLC ” Practice Location

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