Provider Demographics
NPI:1649563396
Name:BLUE STAR HEALTH CARE LLC
Entity Type:Organization
Organization Name:BLUE STAR HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PANNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-258-0840
Mailing Address - Street 1:515 N RIDGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6389
Mailing Address - Country:US
Mailing Address - Phone:316-712-6104
Mailing Address - Fax:
Practice Address - Street 1:515 N RIDGE RD
Practice Address - Street 2:STE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6389
Practice Address - Country:US
Practice Address - Phone:316-712-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based