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General NPI Number Information
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NPI Number | 1538805197
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Entity Type | Organization
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Legal Business Name | OUR STAR FAMILY INC
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 128 FRANKLIN ST
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City | WATERBURY
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State | CT
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Zip | 06706-1204
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Country | US
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Telephone | 518-714-5576
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Fax |
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Provider Business Mailing Address
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Address Line | 299 E SIDNEY AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10553-1021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BETTY GALLIMORE
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Credential |
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Telephone | 518-714-5576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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