Provider Demographics
NPI:1538598081
Name:MEDSTAR HOME HEALTH, LLC
Entity type:Organization
Organization Name:MEDSTAR HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-697-3606
Mailing Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2218
Mailing Address - Country:US
Mailing Address - Phone:561-697-3606
Mailing Address - Fax:561-697-3614
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD STE 700
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2213
Practice Address - Country:US
Practice Address - Phone:561-904-6564
Practice Address - Fax:561-904-6575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIDENT HEALTHCARE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-05
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991617251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107714OtherMEDICARE PTAN