Provider Demographics
NPI:1639935638
Name:TRI-STAR HOME CARE LTD
Entity Type:Organization
Organization Name:TRI-STAR HOME CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOMPHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAVONGSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-899-6469
Mailing Address - Street 1:1632 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1632 GLENEAGLE DR
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-3308
Practice Address - Country:US
Practice Address - Phone:312-899-6469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care