Provider Demographics
NPI:1215285580
Name:PRIME STAR MANAGEMENT INC.
Entity type:Organization
Organization Name:PRIME STAR MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:224-387-9498
Mailing Address - Street 1:5704 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-4584
Mailing Address - Country:US
Mailing Address - Phone:224-387-9498
Mailing Address - Fax:847-742-0460
Practice Address - Street 1:5704 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-4584
Practice Address - Country:US
Practice Address - Phone:224-387-9498
Practice Address - Fax:847-742-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service