Healthcare Provider Details

I. General information

NPI: 1124492707
Provider Name (Legal Business Name): S.T.A.R. NURSING & THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 WOODSON RD SUITE # 1
OVERLAND MO
63114-5671
US

IV. Provider business mailing address

2138 WOODSON RD SUITE # 1
OVERLAND MO
63114-5671
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8650
  • Fax: 314-801-8651
Mailing address:
  • Phone: 314-801-8650
  • Fax: 314-801-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC001468375
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMO

VIII. Authorized Official

Name: MRS. CHRISTINA MARIE CRIDDLE
Title or Position: OWNER/MEMBER
Credential: RN
Phone: 314-801-8650