Provider Demographics
NPI:1932726361
Name:NORTHSTAR HOMECARE LLC
Entity Type:Organization
Organization Name:NORTHSTAR HOMECARE LLC
Other - Org Name:NORTHSTAR HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-459-4573
Mailing Address - Street 1:5239 S 33RD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-7411
Mailing Address - Country:US
Mailing Address - Phone:602-459-4573
Mailing Address - Fax:602-445-9323
Practice Address - Street 1:5239 S 33RD DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-7411
Practice Address - Country:US
Practice Address - Phone:602-459-4753
Practice Address - Fax:602-445-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ008352Medicaid