Provider Demographics
NPI:1609596303
Name:STARLIGHT ASSISTED LIVING AT HUDSON
Entity type:Organization
Organization Name:STARLIGHT ASSISTED LIVING AT HUDSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GULTOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-409-7130
Mailing Address - Street 1:7211 BEACONWOODS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-1975
Mailing Address - Country:US
Mailing Address - Phone:727-857-5927
Mailing Address - Fax:
Practice Address - Street 1:7211 BEACONWOODS DRIVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-1975
Practice Address - Country:US
Practice Address - Phone:727-857-5927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility