MEDICARE: STAR HOME HEALTHCARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700253465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	515 E GRANT ST APT 807
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4600
Country	:	US
Telephone Number	:	612-666-1778
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 E GRANT ST APT 807
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-4600
Country	:	US
Telephone Number	:	612-666-1778
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	NASRA KAHIN
Credential	:
Telephone Number	:	612-666-1778

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/28/2015

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