Provider Demographics
NPI:1386494508
Name:LUCKY STAR CARE HOME LLC
Entity type:Organization
Organization Name:LUCKY STAR CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SOKHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-755-1800
Mailing Address - Street 1:7017 CARMEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3406
Mailing Address - Country:US
Mailing Address - Phone:702-755-1800
Mailing Address - Fax:
Practice Address - Street 1:7017 CARMEN BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3406
Practice Address - Country:US
Practice Address - Phone:702-755-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility