| Starlight Community Services, Inc. | |
|
1885 Lundy Ave Suite 223 And 260 San Jose CA 95131-1888 | |
| (510) 635-9705 | |
| Not Available |
| Full Name | Starlight Community Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1885 Lundy Ave, San Jose, California |
| Authorized Official Name and Position | Kent Dunlap (PRESIDENT AND CHIEF EXECUTIVE OFFIC) |
| Authorized Official Contact | 3102216336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Starlight Community Services, Inc. 1885 Lundy Ave Suite 223 And 260 San Jose CA 95131-1888 Ph: (510) 635-9705 | Starlight Community Services, Inc. 1885 Lundy Ave Suite 223 And 260 San Jose CA 95131-1888 Ph: (510) 635-9705 |
| NPI Number | 1730352303 |
|---|---|
| Provider Enumeration Date | 04/03/2008 |
| Last Update Date | 02/02/2025 |
| Certification Date | 02/02/2025 |
| Medicare PECOS PAC ID | 9436683364 |
|---|---|
| Medicare Enrollment ID | O20241114000581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730352303 | NPI | - | NPPES |
| 2215524 | Other | CA | STATE CORP # |
| 43AG | Other | CA | SANTA CLARA CTY. MED PROV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Pamelah M Stephens |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1295861722 PECOS PAC ID: 2264960863 Enrollment ID: I20250109004128 |
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