Provider Demographics
NPI:1619647716
Name:METRO STAR SERVICES LLC
Entity Type:Organization
Organization Name:METRO STAR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIRVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-388-2272
Mailing Address - Street 1:6039 CYPRESS GARDENS BLVD # 273
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4115
Mailing Address - Country:US
Mailing Address - Phone:646-388-2272
Mailing Address - Fax:
Practice Address - Street 1:276 LAKE ELOISE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5812
Practice Address - Country:US
Practice Address - Phone:646-388-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services