MEDICARE: AMERISTAR HEALTHCARE SERVICES, 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	R2719P	MD

General Provider Information

NPI Number	:	1083853303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERISTAR HEALTHCARE SERVICES, INC,

Provider Business Mailing Address
First Line	:	6604 ADRIAN ST
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3610
Country	:	US
Telephone Number	:	240-965-6572
Fax Number	:	240-965-6574

Provider Business Practice Location Address
First Line	:	6604 ADRIAN ST
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-3610
Country	:	US
Telephone Number	:	240-965-6572
Fax Number	:	240-965-6574

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. WILFRED C. KANDIE
Credential	:
Telephone Number	:	240-965-6572

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	02/10/2009

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