Provider Demographics
NPI:1306512074
Name:5 STAR HEALTH GROUP LLC
Entity type:Organization
Organization Name:5 STAR HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTESINO DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-299-8484
Mailing Address - Street 1:6355 NW 36TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7050
Mailing Address - Country:US
Mailing Address - Phone:786-377-5250
Mailing Address - Fax:786-699-1551
Practice Address - Street 1:6355 NW 36TH ST STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-7050
Practice Address - Country:US
Practice Address - Phone:786-377-5250
Practice Address - Fax:786-699-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113885000Medicaid
FL299995468OtherSTATE LICENSE