1831245489 NPI number — SPECIALIZED TREATMENT AND AFFILIATED RESOURCES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831245489 NPI number — SPECIALIZED TREATMENT AND AFFILIATED RESOURCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED TREATMENT AND AFFILIATED RESOURCES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STAARS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831245489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 E. THIRD STREET SUITE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENDELL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-365-9096
Provider Business Mailing Address Fax Number:
919-365-9097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 E 3RD ST STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENDELL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27591-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-365-9096
Provider Business Practice Location Address Fax Number:
919-365-9097
Provider Enumeration Date:
01/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
EVETTE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
919-365-9096

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: HC3515 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6601584 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3418259 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".