=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619541091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A STARR INNOVATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2021
-----------------------------------------------------
Last Update Date | 12/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 S RURAL RD STE 4N
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-810-2407
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 S RURAL RD STE 4N
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-810-2407
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ANGELIA HILLARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 219-810-2407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------