Provider Demographics
NPI:1629516729
Name:STARBRIGHT PEDIATRIC HOME HEALTH
Entity Type:Organization
Organization Name:STARBRIGHT PEDIATRIC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STARR
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:TAYS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-681-0550
Mailing Address - Street 1:10 BRONCO CT
Mailing Address - Street 2:
Mailing Address - City:PERALTA
Mailing Address - State:NM
Mailing Address - Zip Code:87042-8508
Mailing Address - Country:US
Mailing Address - Phone:505-681-0550
Mailing Address - Fax:
Practice Address - Street 1:10 BRONCO CT
Practice Address - Street 2:
Practice Address - City:PERALTA
Practice Address - State:NM
Practice Address - Zip Code:87042-8508
Practice Address - Country:US
Practice Address - Phone:505-681-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health