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General NPI Number Information
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NPI Number | 1124486204
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Entity Type | Organization
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Legal Business Name | GOLD STAR HOME HEALTHCARE
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 960 E HWY 121 BUSINESS
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City | LEWISVILLE
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State | TX
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Zip | 75057
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Country | US
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Telephone | 502-714-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 3198 PARKWOOD BLVD 12100
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City | FRISCO
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State | TX
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Zip | 75034-9514
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Country | US
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Telephone | 502-714-1573
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MONIQUE BANKS-HALL
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Credential | RN
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Telephone | 502-714-1573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 36987479
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License Number State | TX
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