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General NPI Number Information
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NPI Number | 1851731384
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Entity Type | Organization
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Legal Business Name | GOLDEN STAR HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 4001 W DEVON AVE STE 508
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City | CHICAGO
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State | IL
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Zip | 60646-4540
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Country | US
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Telephone | 708-320-2196
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Fax | 708-320-2959
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Provider Business Mailing Address
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Address Line | 4001 W DEVON AVE STE 508
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City | CHICAGO
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State | IL
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Zip | 60646-4540
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Country | US
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Telephone | 708-320-2196
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Fax | 708-320-2959
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JOSEPHINE S. MILLER
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Credential |
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Telephone | 708-320-2196
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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 | 1011087
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License Number State | IL
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