Provider Demographics
NPI:1679050868
Name:STAR CAPITAL INC
Entity Type:Organization
Organization Name:STAR CAPITAL INC
Other - Org Name:GOOSE CREEK MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FUZAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-225-8735
Mailing Address - Street 1:104 MARILYN ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3104
Mailing Address - Country:US
Mailing Address - Phone:843-572-7442
Mailing Address - Fax:843-553-4043
Practice Address - Street 1:104 MARILYN ST
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3104
Practice Address - Country:US
Practice Address - Phone:843-572-7442
Practice Address - Fax:843-553-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-2027310400000X
SCCRC-2028310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility