Healthcare Provider Details

I. General information

NPI: 1346480761
Provider Name (Legal Business Name): THE FOUNDATION FOR THE STARS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 WATERHOLE ST
LAS VEGAS NV
89130-2907
US

IV. Provider business mailing address

3708 WATERHOLE ST
LAS VEGAS NV
89130-2907
US

V. Phone/Fax

Practice location:
  • Phone: 702-289-0157
  • Fax: 702-302-5026
Mailing address:
  • Phone: 702-289-0157
  • Fax: 702-302-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TRUDY PARKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-289-0157