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General NPI Number Information
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NPI Number | 1629280110
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Entity Type | Organization
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Legal Business Name | SHINING STAR HOME HEALTH CARE INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 713 GATEWOOD RD STE B
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City | GARLAND
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State | TX
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Zip | 75043-8528
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Country | US
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Telephone | 469-366-9767
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Fax | 469-366-9875
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Provider Business Mailing Address
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Address Line | 713 GATEWOOD RD STE B
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City | GARLAND
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State | TX
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Zip | 75043-8528
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Country | US
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Telephone | 469-366-9767
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Fax | 469-366-9875
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SUSAN VATTACHACKAL
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Credential |
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Telephone | 469-366-9767
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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 | 009851
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License Number State | TX
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