Healthcare Provider Details

I. General information

NPI: 1366207730
Provider Name (Legal Business Name): LARGOSTAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD STE 318
LANHAM MD
20706-6231
US

IV. Provider business mailing address

1231 GOOD HOPE ROAD
WASHINGTON DC
20020
US

V. Phone/Fax

Practice location:
  • Phone: 407-801-8991
  • Fax:
Mailing address:
  • Phone: 407-801-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANTHONY OSAGHIE HICKS
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 407-801-8991