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General NPI Number Information
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NPI Number | 1710266432
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Entity Type | Organization
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Legal Business Name | STARFISH HERO, INC.
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 600 F ST SUITE 3-619
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City | ARCATA
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State | CA
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Zip | 95521-6301
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Country | US
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Telephone | 707-845-4584
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Fax | 707-673-5756
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Provider Business Mailing Address
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Address Line | 600 F ST SUITE 3-619
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City | ARCATA
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State | CA
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Zip | 95521-6301
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Country | US
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Telephone | 707-845-4584
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Fax | 707-673-5756
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KIRSTIN L. HALL
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Credential | BCBA
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Telephone | 707-502-2731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-09-9999
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License Number State | CA
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Taxonomy #2
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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 | 1-09-9999
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1-09-9999
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 1-09-9999
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-9999
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License Number State | CA
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