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General NPI Number Information
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NPI Number | 1275357287
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Entity Type | Organization
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Legal Business Name | SUPER STARS CHILD RESEARCH AND DEVELOPMENT CENTER, INC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 5230 JOT EM DOWN RD
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City | CUMMING
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State | GA
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Zip | 30041-3406
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Country | US
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Telephone | 678-249-9206
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Fax |
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Provider Business Mailing Address
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Address Line | 4515 WILDBROOKE PKWY
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City | CUMMING
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State | GA
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Zip | 30041-4824
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Country | US
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Telephone | 678-249-9206
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. SRAVANI GUNDA
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Credential |
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Telephone | 678-249-9206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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