Provider Demographics
NPI:1255202354
Name:BRIGHT STAR RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:BRIGHT STAR RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSAQUOI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:480-708-8512
Mailing Address - Street 1:3108 S 92ND DR
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5541
Mailing Address - Country:US
Mailing Address - Phone:806-341-8658
Mailing Address - Fax:
Practice Address - Street 1:6932 W BEATRICE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-2397
Practice Address - Country:US
Practice Address - Phone:806-341-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-13
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities