MEDICARE: STARLIFE VENTURES, LLC

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	208100000X	Physical Medicine & Rehabilitation Physician		TX
2	261QP2000X	Physical Therapy Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	383146	OTHER	TX	MEDICARE TRADITIONAL

Other Identifiers

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

General Provider Information

NPI Number	:	1144641002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLIFE VENTURES, LLC

Provider Business Mailing Address
First Line	:	10103 FONDREN RD STE 150A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-4556
Country	:	US
Telephone Number	:	713-588-4881
Fax Number	:	281-206-4664

Provider Business Practice Location Address
First Line	:	2755 TEXAS PKWY STE 102
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-5114
Country	:	US
Telephone Number	:	713-588-4881
Fax Number	:	281-206-4664

Authorized Official
Title or Position	:	OWNER
Name	:	STELLA ENELICHI
Credential	:	PT
Telephone Number	:	713-588-4881

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	05/04/2021

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Directions to “STARLIFE VENTURES, LLC ” Practice Location

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