Provider Demographics
NPI:1902279425
Name:AMERISTAR HOME CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:AMERISTAR HOME CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-337-1100
Mailing Address - Street 1:224 BEACH 20TH ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-3618
Mailing Address - Country:US
Mailing Address - Phone:718-337-1100
Mailing Address - Fax:718-337-1101
Practice Address - Street 1:224 BEACH 20TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3618
Practice Address - Country:US
Practice Address - Phone:718-337-1100
Practice Address - Fax:718-337-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health