Provider Demographics
NPI:1003021684
Name:STAR MED HOME HEALTH CARE
Entity Type:Organization
Organization Name:STAR MED HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-627-3945
Mailing Address - Street 1:10535 FOOTHILL BLVD.
Mailing Address - Street 2:SUITE 270
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-989-7224
Mailing Address - Fax:909-989-7223
Practice Address - Street 1:10535 FOOTHILL BLVD.
Practice Address - Street 2:SUITE 270
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-989-7224
Practice Address - Fax:909-989-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000448251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059034Medicare Oscar/Certification