Provider Demographics
NPI:1609413921
Name:STREETLIGHTUSA
Entity Type:Organization
Organization Name:STREETLIGHTUSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-710-3179
Mailing Address - Street 1:8380 W EMILE ZOLA AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4811
Mailing Address - Country:US
Mailing Address - Phone:480-710-3179
Mailing Address - Fax:
Practice Address - Street 1:8380 W EMILE ZOLA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4811
Practice Address - Country:US
Practice Address - Phone:480-710-3179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management