Provider Demographics
NPI:1245225986
Name:5 STAR HEALTHCARE, INC.
Entity Type:Organization
Organization Name:5 STAR HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ANTONIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-382-2166
Mailing Address - Street 1:2093 RAND RD STE LL
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4727
Mailing Address - Country:US
Mailing Address - Phone:224-382-2166
Mailing Address - Fax:847-628-0837
Practice Address - Street 1:2093 RAND RD STE LL
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4727
Practice Address - Country:US
Practice Address - Phone:224-382-2166
Practice Address - Fax:847-628-0837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010292251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
147766OtherMEDICARE
IL=========001Medicaid