Healthcare Provider Details

I. General information

NPI: 1447998455
Provider Name (Legal Business Name): STARNEST LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE
CHICAGO IL
60643-2536
US

IV. Provider business mailing address

10143 S BEVERLY AVE
CHICAGO IL
60643-1347
US

V. Phone/Fax

Practice location:
  • Phone: 872-268-8711
  • Fax:
Mailing address:
  • Phone: 773-383-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA HAMILTON
Title or Position: COACH/CEO
Credential:
Phone: 872-268-8711