Provider Demographics
NPI:1255094942
Name:SHINING STAR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SHINING STAR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FERIAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDRE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM, CDP
Authorized Official - Phone:561-450-6266
Mailing Address - Street 1:4635 CHERRY LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7041
Mailing Address - Country:US
Mailing Address - Phone:561-789-5623
Mailing Address - Fax:561-819-8749
Practice Address - Street 1:16244 S MILITARY TRL STE 460
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6532
Practice Address - Country:US
Practice Address - Phone:561-450-6266
Practice Address - Fax:561-819-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health