Provider Demographics
NPI:1235344961
Name:RAE STAR HEALTH SYSTEMS, INC.
Entity Type:Organization
Organization Name:RAE STAR HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ROJAS
Authorized Official - Last Name:AFAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-881-1091
Mailing Address - Street 1:17215 STUDEBAKER RD.
Mailing Address - Street 2:SUITE 175
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2256
Mailing Address - Country:US
Mailing Address - Phone:562-865-1340
Mailing Address - Fax:562-865-1405
Practice Address - Street 1:17215 STUDEBAKER RD.
Practice Address - Street 2:SUITE 175
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2556
Practice Address - Country:US
Practice Address - Phone:562-865-1340
Practice Address - Fax:562-865-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA980001554251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
980001554OtherSTATE LICENSE
059019Medicare Oscar/Certification