Provider Demographics
NPI:1902259906
Name:SILVER STAR HEALTHCARE LLC
Entity Type:Organization
Organization Name:SILVER STAR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:AHUMADA
Authorized Official - Last Name:TRABADO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, DPT, GCS
Authorized Official - Phone:347-781-2617
Mailing Address - Street 1:9019 WALL ST
Mailing Address - Street 2:APT 5I
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-7015
Mailing Address - Country:US
Mailing Address - Phone:201-293-2168
Mailing Address - Fax:
Practice Address - Street 1:9019 WALL ST
Practice Address - Street 2:APT 5I
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-7015
Practice Address - Country:US
Practice Address - Phone:201-293-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450076673171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty