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General NPI Number Information
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NPI Number | 1215285580
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Entity Type | Organization
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Legal Business Name | PRIME STAR MANAGEMENT INC.
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 5704 RED OAK DR
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-4584
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Country | US
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Telephone | 224-387-9498
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Fax | 847-742-0460
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Provider Business Mailing Address
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Address Line | 5704 RED OAK DR
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-4584
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Country | US
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Telephone | 224-387-9498
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Fax | 847-742-0460
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARIBEL A CABRERA
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Credential | R.N
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Telephone | 224-387-9498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | IL
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