Provider Demographics
NPI:1033370317
Name:STARLIGHT HOME CARE AGENCY, INC
Entity Type:Organization
Organization Name:STARLIGHT HOME CARE AGENCY, INC
Other - Org Name:STAR PEDIATRIC HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZATULOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-836-0500
Mailing Address - Street 1:160 PEHLE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5227
Mailing Address - Country:US
Mailing Address - Phone:201-836-0500
Mailing Address - Fax:201-836-5301
Practice Address - Street 1:160 PEHLE AVE STE 203
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5227
Practice Address - Country:US
Practice Address - Phone:201-836-0500
Practice Address - Fax:201-836-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0153400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0890197Medicaid