=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821119629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR ISD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 S. FM 1047
-----------------------------------------------------
City | STAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-948-3661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 838
-----------------------------------------------------
City | STAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76880-0838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-948-3661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. ANNETTE KEENEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-948-3661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------