Provider Demographics
NPI:1558413476
Name:NORTH STAR CRITICAL CARE LLC
Entity Type:Organization
Organization Name:NORTH STAR CRITICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:LERUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:330-386-9111
Mailing Address - Street 1:16356 STATE ROUTE 267
Mailing Address - Street 2:P.O. BOX 2011
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-3932
Mailing Address - Country:US
Mailing Address - Phone:330-386-9111
Mailing Address - Fax:
Practice Address - Street 1:16356 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-3932
Practice Address - Country:US
Practice Address - Phone:330-386-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009495Medicaid
PA102386522 0001Medicaid
OH2740690Medicaid
OH9367591Medicare PIN