1285113472 NPI number — NORTH STAR CENTER, LLC.

Table of content: (NPI 1285113472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285113472 NPI number — NORTH STAR CENTER, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR 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:
NORTH STAR DAY TREATMENT
Provider Other Organization Name Type Code:
5
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:
1285113472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690 W. STATE STREET
Provider Second Line Business Mailing Address:
PMB 34
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84737-1972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-635-0165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
254 S STATE ST BLDG A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA VERKIN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84745-5633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-635-0165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHQUIN
Authorized Official First Name:
JANETTE
Authorized Official Middle Name:
HAWS
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
435-229-4889

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X , with the licence number:  51933 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X , with the licence number: 63460 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 39297 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 51933 . This is a "DAY TREATMENT LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 39297 . This is a "STATE RTC LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 63460 . This is a "OUTPATIENT TREATMENT LICENSE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".