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General NPI Number Information
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NPI Number | 1376652164
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Entity Type | Organization
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Legal Business Name | FIVE STAR HEALTHCARE LLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 6140 COLEY AVE
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City | LAS VEGAS
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State | NV
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Zip | 89146-5211
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Country | US
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Telephone | 702-248-4130
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Fax | 702-220-8735
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Provider Business Mailing Address
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Address Line | 6140 COLEY AVE
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City | LAS VEGAS
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State | NV
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Zip | 89146-5211
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Country | US
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Telephone | 702-248-4130
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Fax | 702-220-8735
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARITES CASTILLO BUSTAMANTE
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Credential | RN BSN
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Telephone | 702-248-4130
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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 | 540HHA-12
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License Number State | NV
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