Starlight Adolescent

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

32240 Issued in CA

Legal business name

STARLIGHT ADOLESCENT

Practice address

5858 Paddon Cir
San Jose, CA 95123-3522

Phone

(408) 629-5048

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Victoria Remi Oyewole, LPTNPI 1063532208

Title

LPT

Phone

(408) 661-9236

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.

• Victoria R Oyewole

  • Licensed Psychiatric Technician
  • San Jose, CA
  • NPI 1063532208
  NPD (past) Authorized official

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811024789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5858 PADDON CIR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951233522",
            "telephone_number": "408-629-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5858 PADDON CIR",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951233522",
            "telephone_number": "408-629-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STARLIGHT ADOLESCENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OYEWOLE",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "REMI",
        "authorized_official_title_or_position": "LPT",
        "authorized_official_telephone_number": "408-661-9236",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "32240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Ingram Stapleton, PPSC
• Anna Stark, PSY.D.
• Jessica Stark
• Katherine Jean Stark, M.P.T., ATC
• Niel Fisher Starksen, M.D.
• Starlight Adolescent Center
• Starlight Adolescent Center
• Starlight Community Center
• Starlight Community Services
• Starlight Community Services

• Mental Illness Community Based Residential Treatment Facility in San Jose, CA
• Providers in San Jose, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.