1265447015 NPI number — STARLITE RECOVERY CENTER, LLC

Table of content: (NPI 1265447015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265447015 NPI number — STARLITE RECOVERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARLITE RECOVERY CENTER, LLC
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:
STARLITE RECOVERY CENTER
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:
1265447015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTER POINT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78010-0317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-634-2212
Provider Business Mailing Address Fax Number:
830-634-2532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 MESA VERDE DRIVE EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER POINT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-634-2212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4428-4429 . This is a "SUBSTANCE ABUSE TREATMENT FACILITY LICENSE - ADULT OUTPATIENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4428-4431 . This is a "SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-INTENSIVE RESIDENTIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4428-4432 . This is a "SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-INTENSIVE RESIDENTIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4428-4433 . This is a "SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-IR/OP/DETOX-ADOLESCENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4428-4430 . This is a "SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-IR/OP/RESIDENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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