Healthcare Provider Details

I. General information

NPI: 1821430737
Provider Name (Legal Business Name): STAR SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 INNER BANK DR
SOMERSET KY
42503-6542
US

IV. Provider business mailing address

55 INNER BANK DR
SOMERSET KY
42503-6542
US

V. Phone/Fax

Practice location:
  • Phone: 606-392-3847
  • Fax:
Mailing address:
  • Phone: 606-392-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH ANNE DOAN
Title or Position: OWNER/ EXECUTIVE DIRECTOR
Credential: M.ED
Phone: 606-392-3847