Provider Demographics
NPI:1013370626
Name:DAYSTAR HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:DAYSTAR HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-221-0210
Mailing Address - Street 1:6007 FINANCIAL PLZ
Mailing Address - Street 2:SUITE-510
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2655
Mailing Address - Country:US
Mailing Address - Phone:318-221-0210
Mailing Address - Fax:
Practice Address - Street 1:6007 FINANCIAL PLZ
Practice Address - Street 2:SUITE-510
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2655
Practice Address - Country:US
Practice Address - Phone:318-221-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15514251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1884626Medicaid
LA1908053Medicaid
LA1884634Medicaid