Provider Demographics
NPI:1699285726
Name:BLUE STAR CARE SOLUTIONS
Entity type:Organization
Organization Name:BLUE STAR CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-872-4770
Mailing Address - Street 1:1222 E 96TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3903
Mailing Address - Country:US
Mailing Address - Phone:718-872-4770
Mailing Address - Fax:
Practice Address - Street 1:1222 E 96TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3903
Practice Address - Country:US
Practice Address - Phone:718-872-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management