Provider Demographics
NPI:1134156698
Name:NORTH STAR HEALTHCARE, LLC
Entity type:Organization
Organization Name:NORTH STAR HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-465-2106
Mailing Address - Street 1:5401 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1006
Mailing Address - Country:US
Mailing Address - Phone:323-465-2106
Mailing Address - Fax:
Practice Address - Street 1:5401 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1006
Practice Address - Country:US
Practice Address - Phone:323-465-2106
Practice Address - Fax:323-465-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06061HMedicaid
CA1134156698OtherNPI
CAZZT06061HMedicaid
CA056489Medicare Oscar/Certification