Provider Demographics
NPI:1083315071
Name:TWELVE STARS INC
Entity Type:Organization
Organization Name:TWELVE STARS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-916-8529
Mailing Address - Street 1:14883 CRYSTAL VIEW RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9158 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3449
Practice Address - Country:US
Practice Address - Phone:619-357-7753
Practice Address - Fax:619-439-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care