Provider Demographics
NPI:1114431319
Name:BRIGHT OUTSTANDING STARS, LLC
Entity Type:Organization
Organization Name:BRIGHT OUTSTANDING STARS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GURGANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-340-1395
Mailing Address - Street 1:107 SEEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-8095
Mailing Address - Country:US
Mailing Address - Phone:252-340-1395
Mailing Address - Fax:
Practice Address - Street 1:107 SEEVIEW LN
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-8095
Practice Address - Country:US
Practice Address - Phone:252-340-1395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency