MEDICARE: 5 - STAR LIVING, LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417272634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 - STAR LIVING, LLC

Provider Business Mailing Address
First Line	:	4802 LAZY TIMBERS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4455
Country	:	US
Telephone Number	:	281-973-9273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 LAZY TIMBERS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4455
Country	:	US
Telephone Number	:	281-973-9273
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CHERYL KYLE-CHRISTIAN
Credential	:
Telephone Number	:	281-973-9273

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	03/31/2010

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