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General NPI Number Information
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NPI Number | 1518210921
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Entity Type | Organization
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Legal Business Name | FOUR STAR CORPORATE CATERING
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 8271 PEMBROKE RD BLDG 76
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-2101
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Country | US
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Telephone | 954-983-8221
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Fax |
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Provider Business Mailing Address
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Address Line | 8271 PEMBROKE RD BLDG 76
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-2101
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Country | US
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Telephone | 954-983-8221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TOBY STOLAR
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Credential |
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Telephone | 954-983-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number | CAT1620612
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License Number State | FL
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