Provider Demographics
NPI:1639832405
Name:BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE, LLC
Entity Type:Organization
Organization Name:BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PARALEGAL
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-693-2003
Mailing Address - Street 1:1125 TRI STATE PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-9177
Mailing Address - Country:US
Mailing Address - Phone:224-419-3610
Mailing Address - Fax:
Practice Address - Street 1:11430 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1253
Practice Address - Country:US
Practice Address - Phone:260-234-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTSTAR GROUP HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)