Provider Demographics
NPI:1457600835
Name:STARLITE MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:STARLITE MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-468-9373
Mailing Address - Street 1:3785 NW 82ND AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6655
Mailing Address - Country:US
Mailing Address - Phone:305-468-9373
Mailing Address - Fax:305-468-9374
Practice Address - Street 1:3785 NW 82ND AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6655
Practice Address - Country:US
Practice Address - Phone:305-468-9373
Practice Address - Fax:305-468-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9705261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC9705OtherAGENCY FOR HEALTH CARE ADMINISTRATION EXEMPTION