Provider Demographics
NPI:1336760198
Name:MYSTAR HEALTHCARE
Entity Type:Organization
Organization Name:MYSTAR HEALTHCARE
Other - Org Name:MYSTAR HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:ANAEZI
Authorized Official - Last Name:UMELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-740-7462
Mailing Address - Street 1:3749 BENSON DR # 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7324
Mailing Address - Country:US
Mailing Address - Phone:919-740-7462
Mailing Address - Fax:919-964-3369
Practice Address - Street 1:3749 BENSON DR # 104
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7324
Practice Address - Country:US
Practice Address - Phone:919-740-7462
Practice Address - Fax:919-964-3369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYSTAR HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-04
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty