Provider Demographics
NPI:1659780716
Name:STARLIGHT HOSPICE INC
Entity Type:Organization
Organization Name:STARLIGHT HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-663-2257
Mailing Address - Street 1:4959 PALO VERDE ST STE 102B
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2339
Mailing Address - Country:US
Mailing Address - Phone:909-399-3600
Mailing Address - Fax:909-399-3605
Practice Address - Street 1:4959 PALO VERDE ST STE 102B
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2339
Practice Address - Country:US
Practice Address - Phone:951-663-2257
Practice Address - Fax:909-399-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-03
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002977251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based