Provider Demographics
NPI:1124023494
Name:FIVE STAR HOME HEALTH, INC.
Entity Type:Organization
Organization Name:FIVE STAR HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-642-0026
Mailing Address - Street 1:8616 LA TIJERA BLVD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3950
Mailing Address - Country:US
Mailing Address - Phone:310-642-0026
Mailing Address - Fax:310-642-9202
Practice Address - Street 1:8616 LA TIJERA BLVD
Practice Address - Street 2:SUITE 408
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3944
Practice Address - Country:US
Practice Address - Phone:310-642-0026
Practice Address - Fax:310-642-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001521251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08215FMedicaid
CAHHA08215FMedicaid