Provider Demographics
NPI:1790174944
Name:RISING STAR PERSONAL CARE HOME LLC
Entity Type:Organization
Organization Name:RISING STAR PERSONAL CARE HOME LLC
Other - Org Name:RISING STAR HOME HEALTH CARE SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TERRIE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-701-5115
Mailing Address - Street 1:5018 E PONCE DE LEON AVE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1236
Mailing Address - Country:US
Mailing Address - Phone:404-298-0150
Mailing Address - Fax:678-904-5628
Practice Address - Street 1:5018 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1236
Practice Address - Country:US
Practice Address - Phone:404-298-0150
Practice Address - Fax:678-904-5628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RISING STAR HOME HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 343900000X, 374U00000X
GAPCH009075310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty