Provider Demographics
NPI:1316583206
Name:5 STARS HOME CARE SERVICE
Entity Type:Organization
Organization Name:5 STARS HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUSIF
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:ABDELSALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-255-6578
Mailing Address - Street 1:4822 W ST CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-8211
Mailing Address - Country:US
Mailing Address - Phone:336-255-6578
Mailing Address - Fax:
Practice Address - Street 1:4822 W ST CHARLES AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8211
Practice Address - Country:US
Practice Address - Phone:336-255-6578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health