MEDICARE: GOLDEN STAR HOME HEALTH AGENCY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	009951	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013934868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN STAR HOME HEALTH AGENCY INC.

Provider Business Mailing Address
First Line	:	2621 WALNUT CREEK DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 WALNUT CREEK DR
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-4226
Country	:	US
Telephone Number	:	469-726-0760
Fax Number	:	469-726-0761

Authorized Official
Title or Position	:	DON ADMINISTRATOR
Name	:	MRS. COMFORT CHIMATARA NWOKE
Credential	:
Telephone Number	:	469-726-0760

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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