Provider Demographics
NPI:1124486204
Name:GOLD STAR HOME HEALTHCARE
Entity type:Organization
Organization Name:GOLD STAR HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:502-714-1573
Mailing Address - Street 1:3198 PARKWOOD BLVD
Mailing Address - Street 2:12100
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9514
Mailing Address - Country:US
Mailing Address - Phone:502-714-1573
Mailing Address - Fax:
Practice Address - Street 1:960 E HWY 121 BUSINESS
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:502-714-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36987479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health