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General NPI Number Information
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NPI Number | 1316723687
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Entity Type | Organization
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Legal Business Name | RED STAR LLC
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | E2360 COUNTY ROAD HH
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City | ELEVA
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State | WI
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Zip | 54738-9088
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Country | US
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Telephone | 715-713-0074
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Fax | 715-713-0070
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Provider Business Mailing Address
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Address Line | E2360 COUNTY ROAD HH
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City | ELEVA
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State | WI
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Zip | 54738-9088
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Country | US
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Telephone | 715-713-0074
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Fax | 715-713-0070
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RENEE M COLEMAN
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Credential |
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Telephone | 806-316-2326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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