MEDICARE: STARLINE COMMUNITY 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1245301068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARLINE COMMUNITY SERVICES INC

Provider Business Mailing Address
First Line	:	1909 ALTGELD ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-1605
Country	:	US
Telephone Number	:	574-289-0031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 ALTGELD ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-1605
Country	:	US
Telephone Number	:	574-289-0031
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. MOSES MWAURA IV
Credential	:	BUSINESS MANAGER
Telephone Number	:	574-289-0031

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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