Provider Demographics
NPI:1679168819
Name:NSTAR HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:NSTAR HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FUBUH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:404-437-3685
Mailing Address - Street 1:132 STANLEY CT STE G
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9061
Mailing Address - Country:US
Mailing Address - Phone:470-292-3306
Mailing Address - Fax:470-292-3306
Practice Address - Street 1:132 STANLEY CT STE G
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-9061
Practice Address - Country:US
Practice Address - Phone:470-292-3306
Practice Address - Fax:470-292-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty