Provider Demographics
NPI:1619228111
Name:E2 EMERSON AND EMERSON
Entity Type:Organization
Organization Name:E2 EMERSON AND EMERSON
Other - Org Name:DBA BRIGHTSTAR OF WEST SEMINOLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-902-9923
Mailing Address - Street 1:725 PRIMERA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2126
Mailing Address - Country:US
Mailing Address - Phone:407-902-9923
Mailing Address - Fax:
Practice Address - Street 1:725 PRIMERA BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2125
Practice Address - Country:US
Practice Address - Phone:407-549-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health