Provider Demographics
NPI:1316723687
Name:RED STAR LLC
Entity type:Organization
Organization Name:RED STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-316-2326
Mailing Address - Street 1:E2360 COUNTY ROAD HH
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-9088
Mailing Address - Country:US
Mailing Address - Phone:715-713-0074
Mailing Address - Fax:715-713-0070
Practice Address - Street 1:E2360 COUNTY ROAD HH
Practice Address - Street 2:
Practice Address - City:ELEVA
Practice Address - State:WI
Practice Address - Zip Code:54738-9088
Practice Address - Country:US
Practice Address - Phone:715-713-0074
Practice Address - Fax:715-713-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home