Provider Demographics
NPI:1851731384
Name:GOLDEN STAR HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:GOLDEN STAR HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-320-2196
Mailing Address - Street 1:4001 W DEVON AVE STE 508
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4540
Mailing Address - Country:US
Mailing Address - Phone:708-320-2196
Mailing Address - Fax:708-320-2959
Practice Address - Street 1:4001 W DEVON AVE STE 508
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4540
Practice Address - Country:US
Practice Address - Phone:708-320-2196
Practice Address - Fax:708-320-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011087251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health