Healthcare Provider Details

I. General information

NPI: 1598683500
Provider Name (Legal Business Name): NORTHSTAR COORDINATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6673 W WINSTON LN APT 201
BOISE ID
83704-5122
US

IV. Provider business mailing address

6673 W WINSTON LN APT 201
BOISE ID
83704-5122
US

V. Phone/Fax

Practice location:
  • Phone: 208-972-9020
  • Fax:
Mailing address:
  • Phone: 208-972-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED H OSMAN
Title or Position: MANAGEMENT MEMBER
Credential:
Phone: 208-972-9020