Provider Demographics
NPI:1932740966
Name:STARCARE HOMES LLC
Entity Type:Organization
Organization Name:STARCARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:623-261-4051
Mailing Address - Street 1:9416 W COLTER ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-3373
Mailing Address - Country:US
Mailing Address - Phone:623-261-4051
Mailing Address - Fax:623-516-4401
Practice Address - Street 1:9416 W COLTER ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-3373
Practice Address - Country:US
Practice Address - Phone:623-261-4051
Practice Address - Fax:623-516-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty