Provider Demographics
NPI:1871127902
Name:STAR LIGHT LLC
Entity type:Organization
Organization Name:STAR LIGHT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-275-4101
Mailing Address - Street 1:1048 INDEPENDENT AVE STE A119
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-6175
Mailing Address - Country:US
Mailing Address - Phone:970-639-2048
Mailing Address - Fax:
Practice Address - Street 1:1048 INDEPENDENT AVE STE A119
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-6175
Practice Address - Country:US
Practice Address - Phone:970-639-2048
Practice Address - Fax:970-639-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care