Provider Demographics
NPI:1780251967
Name:STARLIGHT GROUP HOME, LLC
Entity type:Organization
Organization Name:STARLIGHT GROUP HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:BELTEJAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:RFA-9318
Authorized Official - Phone:775-762-2162
Mailing Address - Street 1:10515 KENAI DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8319
Mailing Address - Country:US
Mailing Address - Phone:775-762-2162
Mailing Address - Fax:
Practice Address - Street 1:10515 KENAI DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8319
Practice Address - Country:US
Practice Address - Phone:775-762-2162
Practice Address - Fax:775-376-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home