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General NPI Number Information
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NPI Number | 1083315071
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Entity Type | Organization
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Legal Business Name | TWELVE STARS INC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 9158 FLETCHER PKWY
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City | LA MESA
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State | CA
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Zip | 91942-3449
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Country | US
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Telephone | 619-357-7753
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Fax | 619-439-6038
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Provider Business Mailing Address
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Address Line | 14883 CRYSTAL VIEW RD
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City | EL CAJON
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State | CA
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Zip | 92021-2804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CORPORATE SECRETARY
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Name | TAMARA KAKO
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Credential |
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Telephone | 619-916-8529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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