Provider Demographics
NPI:1841258134
Name:FIVE STAR HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:FIVE STAR HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEGBUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-313-0508
Mailing Address - Street 1:8306 BALLINA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6397
Mailing Address - Country:US
Mailing Address - Phone:281-313-0508
Mailing Address - Fax:281-313-0504
Practice Address - Street 1:8306 BALLINA RIDGE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6397
Practice Address - Country:US
Practice Address - Phone:281-313-0508
Practice Address - Fax:281-313-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008382251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679356Medicare Oscar/Certification