Provider Demographics
NPI:1376230714
Name:STARKS, REBEKAH S
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:S
Last Name:STARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 E 9 MILE RD UNIT 41
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3824
Mailing Address - Country:US
Mailing Address - Phone:770-906-4392
Mailing Address - Fax:
Practice Address - Street 1:27441 KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7900
Practice Address - Country:US
Practice Address - Phone:586-585-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care