Provider Demographics
NPI:1598806903
Name:THREE STAR HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:THREE STAR HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:UMUNNAKWE
Authorized Official - Last Name:OGBONNA
Authorized Official - Suffix:
Authorized Official - Credentials:BA MBA
Authorized Official - Phone:214-339-5042
Mailing Address - Street 1:407 N CEDAR RIDGE DR
Mailing Address - Street 2:#325
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3197
Mailing Address - Country:US
Mailing Address - Phone:214-339-5042
Mailing Address - Fax:214-339-2838
Practice Address - Street 1:407 N CEDAR RIDGE DR
Practice Address - Street 2:#325
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3197
Practice Address - Country:US
Practice Address - Phone:214-339-5042
Practice Address - Fax:214-339-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008523251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679380Medicare ID - Type Unspecified