MEDICARE: STAR HOUSE, INC.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1588114540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR HOUSE, INC.

Provider Business Mailing Address
First Line	:	8170 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2067
Country	:	US
Telephone Number	:	702-906-1330
Fax Number	:	702-906-1339

Provider Business Practice Location Address
First Line	:	8170 W SAHARA AVE
Second Line	:	SUITE 202
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2067
Country	:	US
Telephone Number	:	702-906-1330
Fax Number	:	702-906-1339

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. NATASHA SAMUEL
Credential	:
Telephone Number	:	702-906-1330

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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