Provider Demographics
NPI:1730651936
Name:FIVE STAR HOME HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:FIVE STAR HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-251-0308
Mailing Address - Street 1:3044 CONEY ISLAND AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5224
Mailing Address - Country:US
Mailing Address - Phone:718-676-9977
Mailing Address - Fax:718-676-9960
Practice Address - Street 1:3044 CONEY ISLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5224
Practice Address - Country:US
Practice Address - Phone:718-676-9977
Practice Address - Fax:718-676-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04175128Medicaid