Healthcare Provider Details

I. General information

NPI: 1245060904
Provider Name (Legal Business Name): BLUE STAR HOME CARE SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W MAIN AVE 8
GASTONIA NC
28052
US

IV. Provider business mailing address

219 W MAIN AVE STE 8
GASTONIA NC
28052-4140
US

V. Phone/Fax

Practice location:
  • Phone: 704-692-9179
  • Fax: 704-215-5257
Mailing address:
  • Phone: 704-215-5771
  • Fax: 704-215-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KIA E LYNCH
Title or Position: OWNER
Credential:
Phone: 704-215-5771