Healthcare Provider Details

I. General information

NPI: 1952925836
Provider Name (Legal Business Name): ALLSTAR CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11586 AUTUMN TERRACE DR
WHITE MARSH MD
21162-1151
US

IV. Provider business mailing address

11586 AUTUMN TERRACE DR
WHITE MARSH MD
21162-1151
US

V. Phone/Fax

Practice location:
  • Phone: 240-643-8562
  • Fax: 443-378-8818
Mailing address:
  • Phone: 240-643-8562
  • Fax: 443-378-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier555408000
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: DAVID K AMENYAH
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 240-643-8562