1588371942 NPI number — BRIGHT MORNING STAR ASSISTED LIVING FACILITY,INC

Table of content: MICHELLE LEE DONEIS APSW (NPI 1558110494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588371942 NPI number — BRIGHT MORNING STAR ASSISTED LIVING FACILITY,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT MORNING STAR ASSISTED LIVING FACILITY,INC
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:
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:
1588371942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
638 WHITE CRANE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULUOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32766-6673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-483-2546
Provider Business Mailing Address Fax Number:
407-339-0389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULUOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32766-9070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-483-2546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CLERGE
Authorized Official First Name:
ROSELINE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
407-483-2546

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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