Provider Demographics
NPI:1790782696
Name:STAR HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:STAR HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OASIS DATA ENCODER/COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-920-0675
Mailing Address - Street 1:8900 BENSON AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1669
Mailing Address - Country:US
Mailing Address - Phone:909-920-0675
Mailing Address - Fax:909-920-0677
Practice Address - Street 1:8900 BENSON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-1669
Practice Address - Country:US
Practice Address - Phone:909-920-0675
Practice Address - Fax:909-920-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058228Medicare Oscar/Certification