Provider Demographics
NPI:1750389672
Name:DAYSTAR, INC
Entity type:Organization
Organization Name:DAYSTAR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUTIRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-0167
Mailing Address - Street 1:3800 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1616
Mailing Address - Country:US
Mailing Address - Phone:954-473-0167
Mailing Address - Fax:954-473-0202
Practice Address - Street 1:3800 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-1616
Practice Address - Country:US
Practice Address - Phone:954-473-0167
Practice Address - Fax:954-473-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution