Healthcare Provider Details

I. General information

NPI: 1992323141
Provider Name (Legal Business Name): BIG STAR EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 E 29TH AVE
APACHE JUNCTION AZ
85119-6727
US

IV. Provider business mailing address

9538 QUAIL CANYON RD
EL CAJON CA
92021-6710
US

V. Phone/Fax

Practice location:
  • Phone: 619-324-3344
  • Fax:
Mailing address:
  • Phone: 619-324-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STAR IULI
Title or Position: MANAGER
Credential:
Phone: 619-324-3344