Provider Demographics
NPI:1396590188
Name:HEART OF A STAR HOME CARE LLC
Entity type:Organization
Organization Name:HEART OF A STAR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-283-0671
Mailing Address - Street 1:6251 104TH CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1026
Mailing Address - Country:US
Mailing Address - Phone:763-283-0671
Mailing Address - Fax:763-703-5162
Practice Address - Street 1:6430 TOLEDO AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2037
Practice Address - Country:US
Practice Address - Phone:763-283-0670
Practice Address - Fax:763-703-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care