Provider Demographics
NPI:1801623731
Name:BLAZING STAR HOME CARE LLC
Entity type:Organization
Organization Name:BLAZING STAR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT, ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DELNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AJMERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-824-7622
Mailing Address - Street 1:201 E ARMY TRAIL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2103
Mailing Address - Country:US
Mailing Address - Phone:360-824-7622
Mailing Address - Fax:
Practice Address - Street 1:1114 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:GLENDALE HTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3755
Practice Address - Country:US
Practice Address - Phone:360-824-7622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty