Healthcare Provider Details

I. General information

NPI: 1932750544
Provider Name (Legal Business Name): STARFISH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 PAYNE AVE
SAINT PAUL MN
55130-3843
US

IV. Provider business mailing address

PO BOX 17475
SAINT PAUL MN
55117-0475
US

V. Phone/Fax

Practice location:
  • Phone: 651-239-6333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KULCHAREE LOR
Title or Position: PRESIDENT
Credential:
Phone: 651-239-6333