Healthcare Provider Details

I. General information

NPI: 1972331643
Provider Name (Legal Business Name): ACHIEVING STARS WY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 DELL RANGE BLVD STE 200
CHEYENNE WY
82009-4942
US

IV. Provider business mailing address

1133 SAGE ST
FAR ROCKAWAY NY
11691-4820
US

V. Phone/Fax

Practice location:
  • Phone: 833-666-3115
  • Fax: 833-666-3115
Mailing address:
  • Phone: 609-455-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MOSHE HIRSCHMAN
Title or Position: DIRECTOR
Credential:
Phone: 609-455-1123