Provider Demographics
NPI:1639458342
Name:RISING STAR HOME CARE AND TRANSPORT
Entity Type:Organization
Organization Name:RISING STAR HOME CARE AND TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALKINI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:928-675-1356
Mailing Address - Street 1:PO BOX 3397
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-3397
Mailing Address - Country:US
Mailing Address - Phone:928-675-1356
Mailing Address - Fax:
Practice Address - Street 1:2 MILES SW OF BLUE GAP CHAPTER
Practice Address - Street 2:
Practice Address - City:BLUE GAP
Practice Address - State:AZ
Practice Address - Zip Code:86520
Practice Address - Country:US
Practice Address - Phone:928-657-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ624795OtherAHCCCS