Provider Demographics
NPI:1790123826
Name:ALL STARS HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:ALL STARS HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-344-9984
Mailing Address - Street 1:4150 S 100TH EAST AVE STE 200Z
Mailing Address - Street 2:P.O BOX 580323
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3650
Mailing Address - Country:US
Mailing Address - Phone:918-344-9984
Mailing Address - Fax:918-764-8879
Practice Address - Street 1:4150 S 100TH EAST AVE
Practice Address - Street 2:STE. 200Z
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3650
Practice Address - Country:US
Practice Address - Phone:918-344-9984
Practice Address - Fax:918-764-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCSS0043253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care