Healthcare Provider Details

I. General information

NPI: 1982839445
Provider Name (Legal Business Name): STAR CARE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 ALAMO ST SUITE B
LAKE CHARLES LA
70601-8528
US

IV. Provider business mailing address

PO BOX 4610
LAKE CHARLES LA
70606-4610
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-5690
  • Fax:
Mailing address:
  • Phone: 337-312-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRI SELF
Title or Position: BILLING MANAGER
Credential:
Phone: 337-312-1446