MEDICARE: STARRESOURCE, L.L.C.

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	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007852	OTHER	MO	SSBG

General Provider Information

NPI Number	:	1780738237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARRESOURCE, L.L.C.

Provider Business Mailing Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 158
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:	314-432-7827
Fax Number	:	314-432-7828

Provider Business Practice Location Address
First Line	:	11500 OLIVE BLVD
Second Line	:	SUITE 158
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7143
Country	:	US
Telephone Number	:	314-432-7827
Fax Number	:	314-432-7828

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GREG S STARRS
Credential	:
Telephone Number	:	314-432-7827

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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