Provider Demographics
NPI:1649557174
Name:BEACHSTAR HEALTHCARE LLC
Entity Type:Organization
Organization Name:BEACHSTAR HEALTHCARE LLC
Other - Org Name:BRIGHTSTAR OF BRUNSWICK/NEW HANOVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-599-9555
Mailing Address - Street 1:1022 GRANDIFLORA DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7007
Mailing Address - Country:US
Mailing Address - Phone:910-599-9555
Mailing Address - Fax:910-599-9557
Practice Address - Street 1:1022 GRANDIFLORA DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7007
Practice Address - Country:US
Practice Address - Phone:910-599-9555
Practice Address - Fax:910-599-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4476253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care