Healthcare Provider Details

I. General information

NPI: 1386879393
Provider Name (Legal Business Name): NORTHSTAR CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7786 SERVICE CENTER DR
WEST CHESTER OH
45069-2442
US

IV. Provider business mailing address

7786 SERVICE CENTER DR
WEST CHESTER OH
45069-2442
US

V. Phone/Fax

Practice location:
  • Phone: 513-755-9599
  • Fax: 513-755-2824
Mailing address:
  • Phone: 513-755-9599
  • Fax: 513-755-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. HUGH B CLARK
Title or Position: CEO
Credential: MBA
Phone: 513-755-9599