Basic Information
| Provider Information | |||||||||
| NPI: | 1972844801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STARLIGHT COMMUNITY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
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| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4082849000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.