BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE, LLC
NPI 1639832405
Assisted Living Facility in Fort Wayne, IN
- Organization
- Assisted Living Facility
- CLIA Number: 15D2171520
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 09-02-2027
About BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE, LLC
This page provides the complete NPI Profile along with additional information for Brightstar Senior Living Operations Of Fort Wayne, Llc, a provider established in Fort Wayne, Indiana operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1639832405 assigned on October 2021. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Lisa Kasper (Compliance Paralegal)
- NPI
- 1639832405 Verify this NPI
- Provider Name
- BRIGHTSTAR SENIOR LIVING OPERATIONS OF FORT WAYNE, LLC
- Entity Type
- Organization
- Location Address
- 11430 COLDWATER RD FORT WAYNE, IN 46845
- Location Phone
- (260) 234-2929
- Mailing Address
- 1125 TRI STATE PKWY STE 700 GURNEE, IL 60031
- Mailing Phone
- (224) 419-3610
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 10-19-2021
- Last Update Date
- 10-19-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 15D2171520
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- September 03, 2025
- Certificate Expiration Date
- September 02, 2027
- Laboratory Director
- KATHERINE S. BRADY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Brightstar Senior Living Operations Of Fort Wayne, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1639832405, enumerated as an "organization" on October 19, 2021.
The provider is located at 11430 COLDWATER RD FORT WAYNE, IN 46845 and the phone number is (260) 234-2929.
Assisted Living Facility with taxonomy code 310400000X.
