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General NPI Number Information
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NPI Number | 1396590188
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Entity Type | Organization
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Legal Business Name | HEART OF A STAR HOME CARE LLC
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 07/27/2024
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Provider Practice Location Address
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Address Line | 6430 TOLEDO AVE N
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-2037
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Country | US
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Telephone | 763-283-0670
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Fax | 763-703-5162
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Provider Business Mailing Address
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Address Line | 6251 104TH CIR N
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-1026
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Country | US
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Telephone | 763-283-0671
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Fax | 763-703-5162
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Authorized Official
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Title or Position | OWNER
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Name | GERALD SAMUEL GRAY
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Credential |
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Telephone | 763-283-0671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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