MEDICARE: STARLIGHT HEALTHCARE 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	253Z00000X	In Home Supportive Care Agency	IHCP-0362	SC

General Provider Information

NPI Number	:	1639528029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIGHT HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	954 MOUNT GALLANT RD
Second Line	:	A
City	:	ROCK HILL
State	:	SC
Zip	:	29730-2873
Country	:	US
Telephone Number	:	704-451-5531
Fax Number	:	866-523-4376

Provider Business Practice Location Address
First Line	:	954 MOUNT GALLANT RD
Second Line	:	A
City	:	ROCK HILL
State	:	SC
Zip	:	29730-2873
Country	:	US
Telephone Number	:	704-451-5531
Fax Number	:	866-523-4376

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANIEMA UDOH
Credential	:
Telephone Number	:	704-451-5531

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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