1871040477 NPI number — NORTHSTAR HOME HEALTHCARE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871040477 NPI number — NORTHSTAR HOME HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSTAR HOME HEALTHCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871040477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 EAST DUBLIN-GRANVILLE ROAD
Provider Second Line Business Mailing Address:
SUITE 217
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43229-3327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-432-6369
Provider Business Mailing Address Fax Number:
614-335-9084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 EAST DUBLIN-GRANVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43229-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-432-6369
Provider Business Practice Location Address Fax Number:
614-335-9084
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MIRE
Authorized Official First Name:
SHUKRI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-432-6369

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N/A . This is a "N/A" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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