MEDICARE: FIVE STAR HOME HEALTH CARE AGENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	1852L001	NY

General Provider Information

NPI Number	:	1528315397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR HOME HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	1811 KINGS HWY
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1307
Country	:	US
Telephone Number	:	718-676-9977
Fax Number	:	718-676-9960

Provider Business Practice Location Address
First Line	:	1811 KINGS HWY
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1307
Country	:	US
Telephone Number	:	718-676-9977
Fax Number	:	718-676-9960

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. IVETTE MARKOV
Credential	:
Telephone Number	:	718-676-9977

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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