Provider Demographics
NPI:1326808502
Name:STARBOUND HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:STARBOUND HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:AHUMARAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-242-1570
Mailing Address - Street 1:5297 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5297 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1111
Practice Address - Country:US
Practice Address - Phone:937-242-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty