Provider Demographics
NPI:1215656525
Name:PRIME STAR HOME HEALTH, INC.
Entity type:Organization
Organization Name:PRIME STAR HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAILIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-513-8922
Mailing Address - Street 1:624 S BERENDO ST APT 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1749
Mailing Address - Country:US
Mailing Address - Phone:213-513-8922
Mailing Address - Fax:213-513-7869
Practice Address - Street 1:3717 W 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2315
Practice Address - Country:US
Practice Address - Phone:213-513-8922
Practice Address - Fax:213-513-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health