Provider Demographics
NPI:1902467525
Name:GOLDSTAR HOME HEALTH LLC
Entity Type:Organization
Organization Name:GOLDSTAR HOME HEALTH LLC
Other - Org Name:HOME CARE FOR THE 21ST CENTURY - NORTH TUCSON #0001
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-591-0384
Mailing Address - Street 1:7540 N LA CHOLLA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7540 N LA CHOLLA BLVD STE C
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-591-0384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health