Provider Demographics
NPI:1235851767
Name:BRIGHTSTAR ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BRIGHTSTAR ASSISTED LIVING LLC
Other - Org Name:BRIGHTSTAR ASSISTED LIVING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GERMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-864-9098
Mailing Address - Street 1:1613 SW MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4300
Mailing Address - Country:US
Mailing Address - Phone:954-864-9098
Mailing Address - Fax:772-807-1866
Practice Address - Street 1:1613 SW MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4300
Practice Address - Country:US
Practice Address - Phone:954-864-9098
Practice Address - Fax:772-807-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109954800Medicaid