MEDICARE: STAR ADULT DAY CARE CENTER

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1366715732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR ADULT DAY CARE CENTER

Provider Business Mailing Address
First Line	:	28975 GRAND RIVER
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336
Country	:	US
Telephone Number	:	248-469-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	28975 GRAND RIVER AVE
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-5831
Country	:	US
Telephone Number	:	248-469-7111
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MRS. LIA DORINA LUCACI
Credential	:	PTA
Telephone Number	:	248-469-7111

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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