Provider Demographics
NPI:1740708759
Name:PURPLE STARFISH ENTERPRISES LLC
Entity type:Organization
Organization Name:PURPLE STARFISH ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-869-1737
Mailing Address - Street 1:5428 N MESQUITE BOSQUE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5428 N MESQUITE BOSQUE WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1759
Practice Address - Country:US
Practice Address - Phone:520-869-1737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5250385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5250OtherARIZONA DEPARTMENT OF HEALTH SERVICES