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General NPI Number Information
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NPI Number | 1124695341
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Entity Type | Organization
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Legal Business Name | EMERGING STARS FACILITATOR SERVICES, LLC
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 8721 SUNNYBROOKE FARM RD
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-3450
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Country | US
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Telephone | 540-842-6164
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Fax |
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Provider Business Mailing Address
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Address Line | 8721 SUNNYBROOKE FARM RD
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-3450
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Country | US
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Telephone | 540-842-6164
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Fax |
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Authorized Official
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Title or Position | N/A
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Name | KIRK TWIGG
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Credential | N/A
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Telephone | 540-842-6164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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