Provider Demographics
NPI:1053355446
Name:STAR HEALTHCARE LLC
Entity type:Organization
Organization Name:STAR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IVANA
Authorized Official - Middle Name:KATARYNA
Authorized Official - Last Name:HELMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:COF,PTA,CPED,BOCO
Authorized Official - Phone:860-887-5633
Mailing Address - Street 1:1505 TAMIAMI TRL S STE 401B
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5562
Mailing Address - Country:US
Mailing Address - Phone:860-887-5633
Mailing Address - Fax:860-887-5699
Practice Address - Street 1:1505 TAMIAMI TRL S STE 401B
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5562
Practice Address - Country:US
Practice Address - Phone:860-887-5633
Practice Address - Fax:860-887-5699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 224L00000X
MDC10664335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247989Medicaid
82-00812OtherUNITED HEALTHCARE
5047970001Medicare NSC