Provider Demographics
NPI:1982761268
Name:STARLIGHT MEDICAL INC
Entity Type:Organization
Organization Name:STARLIGHT MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-550-3354
Mailing Address - Street 1:100 S ATKINSON RD
Mailing Address - Street 2:SUITE 169
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7817
Mailing Address - Country:US
Mailing Address - Phone:815-550-3354
Mailing Address - Fax:815-550-3355
Practice Address - Street 1:1803 HOLIAN DR
Practice Address - Street 2:SUITE D
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-7934
Practice Address - Country:US
Practice Address - Phone:815-550-3354
Practice Address - Fax:815-550-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000796332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-60031-01Medicaid