MEDICARE: BLUE STAR HOMECARE 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1588217897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STAR HOMECARE LLC

Provider Business Mailing Address
First Line	:	991 FOREST AVE STE 202
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-3330
Country	:	US
Telephone Number	:	207-329-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 MYRTLE ST APT 102
Second Line	:
City	:	BIDDEFORD
State	:	ME
Zip	:	04005-3578
Country	:	US
Telephone Number	:	207-329-1221
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AMIN SHEIKH
Credential	:
Telephone Number	:	207-329-1221

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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Directions to “BLUE STAR HOMECARE LLC ” Practice Location

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