Provider Demographics
NPI:1386753499
Name:METROSTAR HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:METROSTAR HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ DON
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:U
Authorized Official - Last Name:EGWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-331-3133
Mailing Address - Street 1:12300 FORD RD
Mailing Address - Street 2:455
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7248
Mailing Address - Country:US
Mailing Address - Phone:972-331-3133
Mailing Address - Fax:972-331-3135
Practice Address - Street 1:12300 FORD RD
Practice Address - Street 2:455
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7248
Practice Address - Country:US
Practice Address - Phone:972-331-3533
Practice Address - Fax:972-331-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284832701Medicaid
TX747246Medicare PIN