Provider Demographics
NPI:1811182942
Name:MORNING STAR RESIDENCE LLC
Entity type:Organization
Organization Name:MORNING STAR RESIDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-587-6034
Mailing Address - Street 1:91 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2719
Mailing Address - Country:US
Mailing Address - Phone:415-587-6034
Mailing Address - Fax:415-587-6034
Practice Address - Street 1:658 SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2624
Practice Address - Country:US
Practice Address - Phone:415-285-1368
Practice Address - Fax:415-285-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380540234311ZA0620X
CA389210033311ZA0620X
CA389210032311ZA0620X
CA385600364311ZA0620X
CA380540235311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home