Provider Demographics
NPI:1124203237
Name:FIVE STAR HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:FIVE STAR HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR & ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-846-9500
Mailing Address - Street 1:13530 MICHIGAN AVE
Mailing Address - Street 2:STE 328
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3574
Mailing Address - Country:US
Mailing Address - Phone:313-846-9500
Mailing Address - Fax:313-846-0650
Practice Address - Street 1:13530 MICHIGAN AVE
Practice Address - Street 2:STE 328
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3574
Practice Address - Country:US
Practice Address - Phone:313-846-9500
Practice Address - Fax:313-846-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239020Medicare PIN