Provider Demographics
NPI:1578261541
Name:STARLIGHT ASSISTED LINING AT DELAND
Entity Type:Organization
Organization Name:STARLIGHT ASSISTED LINING AT DELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUNELL
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-998-6303
Mailing Address - Street 1:1180 JACKSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7900
Mailing Address - Country:US
Mailing Address - Phone:386-740-9117
Mailing Address - Fax:386-624-6002
Practice Address - Street 1:1180 JACKSON RANCH RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7900
Practice Address - Country:US
Practice Address - Phone:386-740-9117
Practice Address - Fax:386-624-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility