Provider Demographics
NPI:1952925836
Name:ALLSTAR CARE AGENCY, LLC
Entity type:Organization
Organization Name:ALLSTAR CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMENYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-643-8562
Mailing Address - Street 1:11586 AUTUMN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1151
Mailing Address - Country:US
Mailing Address - Phone:240-643-8562
Mailing Address - Fax:443-378-8818
Practice Address - Street 1:11586 AUTUMN TERRACE DR
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-1151
Practice Address - Country:US
Practice Address - Phone:240-643-8562
Practice Address - Fax:443-378-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD555408000Medicaid