Healthcare Provider Details

I. General information

NPI: 1265321152
Provider Name (Legal Business Name): NORTH STAR SENIOR HOME CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14801 MURDOCK ST STE 135
CHANTILLY VA
20151-1040
US

IV. Provider business mailing address

14801 MURDOCK ST STE 135
CHANTILLY VA
20151-1040
US

V. Phone/Fax

Practice location:
  • Phone: 703-651-6792
  • Fax:
Mailing address:
  • Phone: 703-651-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KISHAN S NAINWAL
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-651-6792