Provider Demographics
NPI:1316634272
Name:STAR MED OF KENTUCKY LLC
Entity type:Organization
Organization Name:STAR MED OF KENTUCKY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYSHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:859-309-8552
Mailing Address - Street 1:4156 WESTPORT RD STE 214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2705
Mailing Address - Country:US
Mailing Address - Phone:502-742-0012
Mailing Address - Fax:877-897-8103
Practice Address - Street 1:4156 WESTPORT RD STE 214
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2705
Practice Address - Country:US
Practice Address - Phone:502-742-0012
Practice Address - Fax:877-897-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No342000000XTransportation ServicesTransportation Network Company
No347E00000XTransportation ServicesTransportation Broker