Healthcare Provider Details

I. General information

NPI: 1245478866
Provider Name (Legal Business Name): DAYSTAR PROFESSIONAL SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11207 ASHFORD PT
SUGAR LAND TX
77478-6151
US

IV. Provider business mailing address

11207 ASHFORD PT
SUGAR LAND TX
77478-6151
US

V. Phone/Fax

Practice location:
  • Phone: 281-265-2340
  • Fax:
Mailing address:
  • Phone: 281-265-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number012078
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number0096073
License Number StateTX

VIII. Authorized Official

Name: MRS. YVONNE JOBE
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 281-265-2340