Provider Demographics
NPI:1205128147
Name:SHINING STAR HOME CARE, LLC.
Entity type:Organization
Organization Name:SHINING STAR HOME CARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-435-4700
Mailing Address - Street 1:6024 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5085
Mailing Address - Country:US
Mailing Address - Phone:718-435-4700
Mailing Address - Fax:718-435-4775
Practice Address - Street 1:6024 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5085
Practice Address - Country:US
Practice Address - Phone:718-435-4700
Practice Address - Fax:718-435-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072094B251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7001638OtherNYS LICENSE
NY03438497Medicaid
NY03438497Medicaid
NY072094BMedicare Oscar/Certification