Provider Demographics
NPI:1477630812
Name:STARLIGHT CTF, INC.
Entity Type:Organization
Organization Name:STARLIGHT CTF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MN, RN
Authorized Official - Phone:510-635-9705
Mailing Address - Street 1:455 SILICON VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1858
Mailing Address - Country:US
Mailing Address - Phone:408-284-9000
Mailing Address - Fax:
Practice Address - Street 1:455 SILICON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1858
Practice Address - Country:US
Practice Address - Phone:408-284-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1883.08.01251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2089602OtherSTATE BIZ LICENSE
CA1883.08.01OtherDSS PROGRAM