Provider Demographics
NPI:1003272949
Name:BRIGHTSTAR OF PEMBROKE PINES
Entity Type:Organization
Organization Name:BRIGHTSTAR OF PEMBROKE PINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-518-3420
Mailing Address - Street 1:3600 RED RD
Mailing Address - Street 2:STE 306
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 RED RD
Practice Address - Street 2:STE 306
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6013
Practice Address - Country:US
Practice Address - Phone:954-518-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994490251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health