MEDICARE: STARLIGHT COMMUNITY SERVICES, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457113953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	6203 SAN IGNACIO AVE STE 150
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1371
Country	:	US
Telephone Number	:	408-270-4992
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 SENTER RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1332
Country	:	US
Telephone Number	:	408-270-4992
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CHIEF EXECUTIVE OFFIC
Name	:	KENT DUNLAP
Credential	:
Telephone Number	:	310-221-6336

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	05/12/2025

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