1124692041 NPI number — STAR LIGHT HEALTHCARE SERVICES, LLC

Table of content: DR. LAURA LEE SMITH BENEKE MD (NPI 1487116604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124692041 NPI number — STAR LIGHT HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR LIGHT HEALTHCARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124692041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1404 HAWK PKWY UNIT 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81401-6470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-414-1650
Provider Business Mailing Address Fax Number:
970-650-4237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1404 HAWK PKWY UNIT 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTROSE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81401-6470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-414-1650
Provider Business Practice Location Address Fax Number:
970-650-4237
Provider Enumeration Date:
05/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VRADENBURG
Authorized Official First Name:
KITTY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
970-414-1650

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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