Healthcare Provider Details

I. General information

NPI: 1710266432
Provider Name (Legal Business Name): STARFISH HERO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 F ST SUITE 3-619
ARCATA CA
95521-6301
US

IV. Provider business mailing address

600 F ST SUITE 3-619
ARCATA CA
95521-6301
US

V. Phone/Fax

Practice location:
  • Phone: 707-845-4584
  • Fax: 707-673-5756
Mailing address:
  • Phone: 707-845-4584
  • Fax: 707-673-5756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-9999
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1-09-9999
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-09-9999
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-09-9999
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1-09-9999
License Number StateCA

VIII. Authorized Official

Name: MS. KIRSTIN L. HALL
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 707-502-2731