MEDICARE: NORTH STAR COMPLETE HOME AND HEALTH CARE

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	311Z00000X	Custodial Care Facility	245874	FL

General Provider Information

NPI Number	:	1366711269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR COMPLETE HOME AND HEALTH CARE

Provider Business Mailing Address
First Line	:	238 SE WHITMORE DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-3740
Country	:	US
Telephone Number	:	414-305-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 SE WHITMORE DR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34984-3740
Country	:	US
Telephone Number	:	414-305-5714
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GWENDA LYNN KULCSAR
Credential	:
Telephone Number	:	414-305-5714

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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