Provider Demographics
NPI:1588051114
Name:BLUE STAR REHABILITATION, LLC
Entity type:Organization
Organization Name:BLUE STAR REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-796-7205
Mailing Address - Street 1:800 W AIRPORT FWY STE 959
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6312
Mailing Address - Country:US
Mailing Address - Phone:972-445-4134
Mailing Address - Fax:972-445-4135
Practice Address - Street 1:800 W AIRPORT FWY STE 959
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6312
Practice Address - Country:US
Practice Address - Phone:972-445-4134
Practice Address - Fax:972-445-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty