Provider Demographics
NPI:1235686007
Name:AMAZING STAR HOMES CORPORATION
Entity Type:Organization
Organization Name:AMAZING STAR HOMES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:ETUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-819-3230
Mailing Address - Street 1:861 GLENROCK RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3720
Mailing Address - Country:US
Mailing Address - Phone:757-819-3230
Mailing Address - Fax:757-893-9266
Practice Address - Street 1:861 GLENROCK RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3720
Practice Address - Country:US
Practice Address - Phone:757-819-3230
Practice Address - Fax:757-893-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001120196164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty