Provider Demographics
NPI:1801204854
Name:SHINING STAR HOME CARE
Entity Type:Organization
Organization Name:SHINING STAR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-327-8375
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-0131
Mailing Address - Country:US
Mailing Address - Phone:323-327-8375
Mailing Address - Fax:323-357-5901
Practice Address - Street 1:10504 WEIGAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3866
Practice Address - Country:US
Practice Address - Phone:323-327-8375
Practice Address - Fax:323-357-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care