Provider Demographics
NPI:1407870017
Name:MEDSTAR HOME CARE, INC.
Entity Type:Organization
Organization Name:MEDSTAR HOME CARE, INC.
Other - Org Name:PRESCRIBED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-324-4663
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1465
Mailing Address - Country:US
Mailing Address - Phone:248-324-4663
Mailing Address - Fax:248-324-4664
Practice Address - Street 1:2820 W MAPLE RD STE 201A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7064
Practice Address - Country:US
Practice Address - Phone:248-324-4663
Practice Address - Fax:248-324-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
237673Medicare Oscar/Certification