Provider Demographics
NPI:1871820209
Name:CLTA, LLC
Entity Type:Organization
Organization Name:CLTA, LLC
Other - Org Name:BRIGHTSTAR OF CHARLESTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-452-9656
Mailing Address - Street 1:4130 FABER PLACE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8501
Mailing Address - Country:US
Mailing Address - Phone:843-452-9656
Mailing Address - Fax:
Practice Address - Street 1:4130 FABER PLACE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8501
Practice Address - Country:US
Practice Address - Phone:843-452-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health