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General NPI Number Information
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NPI Number | 1922136498
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Entity Type | Organization
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Legal Business Name | THE FOUNDATION FOR THE S.T.A.R.S.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 3708 WATERHOLE ST
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City | LAS VEGAS
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State | NV
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Zip | 89130-2907
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Country | US
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Telephone | 702-515-1761
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Fax | 702-515-1761
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Provider Business Mailing Address
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Address Line | PO BOX 530063
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City | HENDERSON
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State | NV
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Zip | 89053-0063
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Country | US
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Telephone | 702-289-0157
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Fax | 702-892-0938
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TRUDY ANISE PARKS
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Credential |
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Telephone | 702-289-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | GF-125401040-0001
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License Number State | NV
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