MEDICARE: 5 STARS HOME CARE SERVICE

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1316583206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STARS HOME CARE SERVICE

Provider Business Mailing Address
First Line	:	4822 W ST CHARLES AVE
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-8211
Country	:	US
Telephone Number	:	336-255-6578
Fax Number	:

Provider Business Practice Location Address
First Line	:	4822 W ST CHARLES AVE
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-8211
Country	:	US
Telephone Number	:	336-255-6578
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOUSIF OMER ABDELSALAM
Credential	:
Telephone Number	:	336-255-6578

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	11/26/2019

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