Provider Demographics
NPI:1841608635
Name:BRILLIANT STARS INC.
Entity Type:Organization
Organization Name:BRILLIANT STARS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:CAPRON
Authorized Official - Last Name:ALTIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-527-9325
Mailing Address - Street 1:2500 HOLLYWOOD BLVD
Mailing Address - Street 2:403
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6615
Mailing Address - Country:US
Mailing Address - Phone:954-347-8500
Mailing Address - Fax:954-920-9875
Practice Address - Street 1:2500 HOLLYWOOD BLVD
Practice Address - Street 2:403
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:954-347-8500
Practice Address - Fax:954-920-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012700800Medicaid
FL000950700Medicaid