Provider Demographics
NPI:1902268535
Name:DOTNA STAR LLC
Entity Type:Organization
Organization Name:DOTNA STAR LLC
Other - Org Name:DOTNA HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:469-347-0609
Mailing Address - Street 1:17811 VAIL ST
Mailing Address - Street 2:APT 20202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6460
Mailing Address - Country:US
Mailing Address - Phone:469-347-0609
Mailing Address - Fax:
Practice Address - Street 1:17811 VAIL ST
Practice Address - Street 2:APT 20202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6460
Practice Address - Country:US
Practice Address - Phone:469-347-0609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802397878Medicaid