Provider Demographics
NPI:1629371083
Name:FIVESTAR HOME HEALTH CARE
Entity Type:Organization
Organization Name:FIVESTAR HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OZZIE
Authorized Official - Middle Name:AMENDA
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:614-376-3139
Mailing Address - Street 1:1239 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2648
Mailing Address - Country:US
Mailing Address - Phone:614-376-3139
Mailing Address - Fax:
Practice Address - Street 1:1239 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2648
Practice Address - Country:US
Practice Address - Phone:614-376-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health