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General NPI Number Information
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NPI Number | 1417738204
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Entity Type | Organization
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Legal Business Name | 5 STAR PREMIUM HOME CARE INC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1175 NE 125TH ST STE 209
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5008
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Country | US
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Telephone | 305-456-5537
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Fax | 305-759-0488
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Provider Business Mailing Address
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Address Line | 1175 NE 125TH ST STE 209
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5008
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Country | US
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Telephone | 305-456-5537
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Fax | 305-759-0488
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Authorized Official
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Title or Position | OWNER
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Name | DYLAN FILS-AIME
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Credential |
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Telephone | 305-456-5537
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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 |
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License Number State |
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