Healthcare Provider Details

I. General information

NPI: 1790782696
Provider Name (Legal Business Name): STAR HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BENSON AVE SUITE F
MONTCLAIR CA
91763-1669
US

IV. Provider business mailing address

8900 BENSON AVE SUITE F
MONTCLAIR CA
91763-1669
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0675
  • Fax: 909-920-0677
Mailing address:
  • Phone: 909-920-0675
  • Fax: 909-920-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MILES R. BALLESTEROS
Title or Position: OASIS DATA ENCODER/COORDINATOR
Credential:
Phone: 909-920-0675