Provider Demographics
NPI:1467099341
Name:TWINKLE-STAR HOME SERVICES LLC
Entity Type:Organization
Organization Name:TWINKLE-STAR HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:UMELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-539-9223
Mailing Address - Street 1:2204 HAVERING PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0801
Mailing Address - Country:US
Mailing Address - Phone:919-539-9223
Mailing Address - Fax:
Practice Address - Street 1:1921 WATERS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4836
Practice Address - Country:US
Practice Address - Phone:919-539-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC201919301765Medicaid