Provider Demographics
NPI:1437652401
Name:BRIGHTSTAR CRDM, LLC
Entity Type:Organization
Organization Name:BRIGHTSTAR CRDM, LLC
Other - Org Name:BRIGHTSTAR CARE CRDM, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CORPORATE LOCATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-361-5893
Mailing Address - Street 1:1125 TRI STATE PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5340 N PARK PL NE STE 202
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6235
Practice Address - Country:US
Practice Address - Phone:319-363-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health