Provider Demographics
NPI:1770285702
Name:STARLIGHT FACILITY INC
Entity type:Organization
Organization Name:STARLIGHT FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:TADEVOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-378-7069
Mailing Address - Street 1:7647 TUJUNGA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-2937
Mailing Address - Country:US
Mailing Address - Phone:818-378-7069
Mailing Address - Fax:
Practice Address - Street 1:7647 TUJUNGA AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-2937
Practice Address - Country:US
Practice Address - Phone:818-378-7069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385H00000XRespite Care FacilityRespite Care