Provider Demographics
NPI:1740705649
Name:5 STAR HOME CARE INC
Entity type:Organization
Organization Name:5 STAR HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:IVATOROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-633-3333
Mailing Address - Street 1:4703 HIGHWAY 17 BYP S STE B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6693
Mailing Address - Country:US
Mailing Address - Phone:843-633-3333
Mailing Address - Fax:843-294-0140
Practice Address - Street 1:4703 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6693
Practice Address - Country:US
Practice Address - Phone:843-633-3333
Practice Address - Fax:843-294-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPENDING251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1712Medicaid