Provider Demographics
NPI:1851359194
Name:FIVE STAR HOME HEALTH, INC.
Entity Type:Organization
Organization Name:FIVE STAR HOME HEALTH, INC.
Other - Org Name:ANGELS CARE HOME HEALTH OF EAST OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-469-6937
Mailing Address - Street 1:2301 HIGHWAY 1187
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6124
Mailing Address - Country:US
Mailing Address - Phone:817-469-6937
Mailing Address - Fax:817-801-3486
Practice Address - Street 1:751 N ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2224
Practice Address - Country:US
Practice Address - Phone:918-251-0952
Practice Address - Fax:918-251-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK007179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377171Medicare Oscar/Certification