Healthcare Provider Details

I. General information

NPI: 1235415316
Provider Name (Legal Business Name): STARRVISTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22390 W 7 MILE RD
DETROIT MI
48219-1849
US

IV. Provider business mailing address

22390 W 7 MILE RD
DETROIT MI
48219-1849
US

V. Phone/Fax

Practice location:
  • Phone: 313-387-6000
  • Fax: 313-387-0760
Mailing address:
  • Phone: 313-387-6000
  • Fax: 313-387-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM CHUCK JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-387-1238