Provider Demographics
NPI:1558503268
Name:BIEN STAR HOME HEALTH
Entity Type:Organization
Organization Name:BIEN STAR HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALVA
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:LARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-589-1921
Mailing Address - Street 1:210 MESAVERDE ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063
Mailing Address - Country:US
Mailing Address - Phone:575-589-1921
Mailing Address - Fax:575-589-1921
Practice Address - Street 1:3907 MCNUTT RD
Practice Address - Street 2:UNIT D
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9055
Practice Address - Country:US
Practice Address - Phone:575-589-1921
Practice Address - Fax:575-589-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM08000262253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care