Provider Demographics
NPI:1730444720
Name:BRIGHTSTAR CSD, LLC
Entity type:Organization
Organization Name:BRIGHTSTAR CSD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-693-2040
Mailing Address - Street 1:5830 OBERLIN DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3703
Mailing Address - Country:US
Mailing Address - Phone:858-777-9525
Mailing Address - Fax:858-777-9551
Practice Address - Street 1:5830 OBERLIN DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3703
Practice Address - Country:US
Practice Address - Phone:858-777-9525
Practice Address - Fax:858-777-9551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTSTAR GROUP HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health