MEDICARE: FIVE STAR HOME HEALTH, 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	980001521	CA

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	:	1124023494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3950
Country	:	US
Telephone Number	:	310-642-0026
Fax Number	:	310-642-9202

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3944
Country	:	US
Telephone Number	:	310-642-0026
Fax Number	:	310-642-9202

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANTHONY NIEVES
Credential	:
Telephone Number	:	310-642-0026

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/27/2013

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