Healthcare Provider Details

I. General information

NPI: 1619647716
Provider Name (Legal Business Name): METRO STAR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 LAKE ELOISE POINTE BLVD
WINTER HAVEN FL
33880-5812
US

IV. Provider business mailing address

6039 CYPRESS GARDENS BLVD # 273
WINTER HAVEN FL
33884-4115
US

V. Phone/Fax

Practice location:
  • Phone: 646-388-2272
  • Fax:
Mailing address:
  • Phone: 646-388-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NIRVANA BAIL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 646-388-2272