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General NPI Number Information
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NPI Number | 1154430270
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Entity Type | Organization
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Legal Business Name | STAR CENTER, INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 13575 LESURE ST
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City | DETROIT
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State | MI
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Zip | 48227-3131
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Country | US
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Telephone | 313-493-4410
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Fax | 313-493-4415
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Provider Business Mailing Address
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Address Line | 13575 LESURE ST
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City | DETROIT
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State | MI
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Zip | 48227-3131
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Country | US
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Telephone | 313-493-4410
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Fax | 313-493-4415
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MR. RENE R. SAENZ
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Credential |
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Telephone | 313-493-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 821426
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License Number State | MI
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