Provider Demographics
NPI:1124880810
Name:MAVERICK STAR HOME HEALTH CARE
Entity type:Organization
Organization Name:MAVERICK STAR HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:WANGUI
Authorized Official - Last Name:WANJIKU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:412-853-9752
Mailing Address - Street 1:16734 SHURMER RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6125
Mailing Address - Country:US
Mailing Address - Phone:419-378-1469
Mailing Address - Fax:
Practice Address - Street 1:16734 SHURMER RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6125
Practice Address - Country:US
Practice Address - Phone:419-378-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health