Healthcare Provider Details

I. General information

NPI: 1003368655
Provider Name (Legal Business Name): STARSHINE TREATMENT CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 E HIGHLAND AVE STE 215
SAN BERNARDINO CA
92404-6804
US

IV. Provider business mailing address

1255 E HIGHLAND AVE STE 215
SAN BERNARDINO CA
92404-6804
US

V. Phone/Fax

Practice location:
  • Phone: 909-882-7978
  • Fax:
Mailing address:
  • Phone: 909-882-7978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES PACE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 909-882-7978