Healthcare Provider Details

I. General information

NPI: 1396466306
Provider Name (Legal Business Name): MINDSTAR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PROMENADE CIR STE 300
SACRAMENTO CA
95834-2952
US

IV. Provider business mailing address

180 PROMENADE CIR STE 300
SACRAMENTO CA
95834-2952
US

V. Phone/Fax

Practice location:
  • Phone: 916-903-2538
  • Fax: 916-634-7701
Mailing address:
  • Phone: 916-903-2538
  • Fax: 916-634-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TERRELL GRANT
Title or Position: DIRECTOR
Credential:
Phone: 530-902-6336