Provider Demographics
NPI:1902108988
Name:FIVE STAR LLC
Entity Type:Organization
Organization Name:FIVE STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-789-2653
Mailing Address - Street 1:3297 ROXMERE DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1735
Mailing Address - Country:US
Mailing Address - Phone:727-278-9265
Mailing Address - Fax:
Practice Address - Street 1:3297 ROXMERE DR
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1735
Practice Address - Country:US
Practice Address - Phone:727-278-9265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies