1093832180 NPI number — STTAR CENTER INC

Table of content: (NPI 1093832180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093832180 NPI number — STTAR CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STTAR CENTER 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:
Provider Other Organization Name Type Code:
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:
1093832180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9810 PATUXENT WOODS DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046-1595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-290-6432
Provider Business Mailing Address Fax Number:
410-290-6604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9810 PATUXENT WOODS DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21046-1595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-290-6432
Provider Business Practice Location Address Fax Number:
410-290-6604
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DILLINGHAM
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
JEANNIE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-290-6432

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: KK48TH . This is a "CAREFIRST BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4609758 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 554418000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 447531300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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