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General NPI Number Information
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NPI Number | 1457287385
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Entity Type | Organization
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Legal Business Name | COPPER STAR CARE LLC
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 16974 S RUSTLING LEAF TRL
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City | VAIL
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State | AZ
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Zip | 85641-8748
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Country | US
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Telephone | 520-703-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 16974 S RUSTLING LEAF TRL
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City | VAIL
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State | AZ
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Zip | 85641-8748
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Country | US
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Telephone | 520-703-0064
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON ALYSSA KENNEDY
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Credential | CHW
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Telephone | 520-703-0064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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