MEDICARE: STAR CENTER GROUP 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1396082004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR CENTER GROUP INC

Provider Business Mailing Address
First Line	:	5958 VINELAND AVE
Second Line	:	SUITE K
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1329
Country	:	US
Telephone Number	:	818-821-6854
Fax Number	:	818-821-6856

Provider Business Practice Location Address
First Line	:	5958 VINELAND AVE
Second Line	:	SUITE K
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1329
Country	:	US
Telephone Number	:	818-579-4342
Fax Number	:	818-821-6856

Authorized Official
Title or Position	:	CEO
Name	:	MARINE A. KESHISHIAN
Credential	:	RN
Telephone Number	:	818-821-6854

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	03/30/2016

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