1841608635 NPI number — BRILLIANT STARS INC.

Table of content: (NPI 1841608635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841608635 NPI number — BRILLIANT STARS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRILLIANT STARS 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:
1841608635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
403
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33020-6615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-347-8500
Provider Business Mailing Address Fax Number:
954-920-9875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
403
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33020-6615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-347-8500
Provider Business Practice Location Address Fax Number:
954-920-9875
Provider Enumeration Date:
07/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ALTIDOR
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
CAPRON
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-527-9325

Provider Taxonomy Codes

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

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

  • Identifier: 012700800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000950700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012700800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com