Healthcare Provider Details

I. General information

NPI: 1164001616
Provider Name (Legal Business Name): SUPERSTAR KIDS SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4271 NEPTUNE RD
SAINT CLOUD FL
34769-6744
US

IV. Provider business mailing address

4271 NEPTUNE RD
SAINT CLOUD FL
34769-6744
US

V. Phone/Fax

Practice location:
  • Phone: 407-308-2666
  • Fax:
Mailing address:
  • Phone: 407-308-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA EUGENIA VEGA
Title or Position: PRESIDENT
Credential:
Phone: 407-308-2666