Healthcare Provider Details

I. General information

NPI: 1063316156
Provider Name (Legal Business Name): NORTHSTAR COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 S JUNIPER CT
MILLIKEN CO
80543-9466
US

IV. Provider business mailing address

676 S JUNIPER CT
MILLIKEN CO
80543-9466
US

V. Phone/Fax

Practice location:
  • Phone: 970-443-8896
  • Fax:
Mailing address:
  • Phone: 970-443-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZUZANA POLAKOVA
Title or Position: OWNER
Credential:
Phone: 970-443-8896