Provider Demographics
NPI:1891901997
Name:NORTH STAR HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:NORTH STAR HOME HEALTH SERVICES, INC.
Other - Org Name:NORTH STAR HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-275-4667
Mailing Address - Street 1:1340 PRUDENTIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4115
Mailing Address - Country:US
Mailing Address - Phone:214-275-4667
Mailing Address - Fax:214-275-5273
Practice Address - Street 1:1340 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4115
Practice Address - Country:US
Practice Address - Phone:214-275-4667
Practice Address - Fax:214-275-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009213251E00000X
TX013506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000630700Medicaid
TX001018833Medicaid
TX000035600Medicaid
TX001018832Medicaid
TX000035600Medicaid