Provider Demographics
NPI:1073671871
Name:ALLSTAR HOMECARE LLC
Entity Type:Organization
Organization Name:ALLSTAR HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-925-2800
Mailing Address - Street 1:3537 PRUDEN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-7246
Mailing Address - Country:US
Mailing Address - Phone:757-925-2800
Mailing Address - Fax:757-925-4999
Practice Address - Street 1:3537 PRUDEN BLVD STE D
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-7246
Practice Address - Country:US
Practice Address - Phone:757-925-2800
Practice Address - Fax:757-925-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497591Medicare Oscar/Certification