Bright Star Memory Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

BRIGHT STAR MEMORY CARE LLC

Practice address

2 Lakeway PL
Simpsonville, SC 29681-4781

Phone

(240) 498-1879

NPI assigned

Jul 21, 2021

Last updated

Jul 21, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sia KombaNPI 1518587807

Title

Owner

Phone

(240) 498-1879

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sia Komba, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Greenville, SC
  • NPI 1518587807
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1184297822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 LAKEWAY PL",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296814781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 LAKEWAY PL",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296814781",
            "telephone_number": "240-498-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT STAR MEMORY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "KOMBA",
        "authorized_official_first_name": "SIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-498-1879"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• In Home Supportive Care Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.