Provider Demographics
NPI:1326297029
Name:SUPER STAR STAFF COORDINATOR SERVICE,INC
Entity Type:Organization
Organization Name:SUPER STAR STAFF COORDINATOR SERVICE,INC
Other - Org Name:SUPER STAR HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-556-2880
Mailing Address - Street 1:1490 W 49TH PL STE 445
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3196
Mailing Address - Country:US
Mailing Address - Phone:305-556-2880
Mailing Address - Fax:
Practice Address - Street 1:1490 W 49TH PL STE 445
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3196
Practice Address - Country:US
Practice Address - Phone:305-556-2880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No291U00000XLaboratoriesClinical Medical Laboratory