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General NPI Number Information
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NPI Number | 1588557268
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Entity Type | Organization
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Legal Business Name | STARS BEHAVIORAL HEALTH GROUP- VALLEY STAR THE STAY
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Dates
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Enumeration Date | 05/31/2025
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Last Update Date | 05/31/2025
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Provider Practice Location Address
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Address Line | 780 E GILBERT ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-1003
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Country | US
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Telephone | 909-763-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 780 E GILBERT ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-1003
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Country | US
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Telephone | 909-763-4760
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Fax |
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Authorized Official
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Title or Position | LPT
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Name | MAYRA MARTINEZ
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Credential | LPT
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Telephone | 909-763-4760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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