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Organization
STARLIGHT ADOLESCENT CENTER
Active
Organization
STARLIGHT ADOLESCENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JANE GROSS RN, MA (PRESIDENT)
(510) 635-9705
Entity
Organization
Contact information
Practice address
455 SILICON VALLEY BLVD, SAN JOSE, CA 95138-1858
(408) 284-9000
(408) 284-9048
Mailing address
455 SILICON VALLEY BLVD, SAN JOSE, CA 95138-1858
(408) 284-9000
(408) 284-9048
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2215524
STATE CORP #
CA
01
—
43AG
SANTA CLARA CTY. MED PROV
CA
Enumeration date
09/28/2006
Last updated
08/22/2020
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