Provider Demographics
NPI:1710910419
Name:FOUR STAR HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:FOUR STAR HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWANKPA
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:512-446-5335
Mailing Address - Street 1:1915 S AUSTIN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7843
Mailing Address - Country:US
Mailing Address - Phone:512-864-9994
Mailing Address - Fax:512-864-9954
Practice Address - Street 1:1915 S AUSTIN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7843
Practice Address - Country:US
Practice Address - Phone:512-864-9994
Practice Address - Fax:512-864-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009344251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
673127Medicare Oscar/Certification