1972514867 NPI number — S.T.A.R. THERAPY CLINIC, 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 1972514867 NPI number — S.T.A.R. THERAPY CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.T.A.R. THERAPY CLINIC, 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:
1972514867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7726 N. FIRST ST. #118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-449-9394
Provider Business Mailing Address Fax Number:
559-449-8287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6121 N THESTA ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-8603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-449-9394
Provider Business Practice Location Address Fax Number:
559-449-8287
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWNELL
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER/RPT
Authorized Official Telephone Number:
559-449-9394

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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