Provider Demographics
NPI:1700405735
Name:HEALTHSTAR HOME HEALTH, INC.
Entity Type:Organization
Organization Name:HEALTHSTAR HOME HEALTH, INC.
Other - Org Name:HEALTHSTAR HOME HEALTH & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-789-8769
Mailing Address - Street 1:2586 7TH AVE E STE 302
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3090
Mailing Address - Country:US
Mailing Address - Phone:651-789-8769
Mailing Address - Fax:
Practice Address - Street 1:2701 W SUPERIOR ST STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1857
Practice Address - Country:US
Practice Address - Phone:218-626-6777
Practice Address - Fax:651-305-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based