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General NPI Number Information
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NPI Number | 1952840183
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Entity Type | Organization
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Legal Business Name | GLOBE STAR, LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 935 S IRONWOOD DR
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City | SOUTH BEND
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State | IN
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Zip | 46615-1613
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Country | US
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Telephone | 219-921-5492
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Fax | 219-921-0143
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Provider Business Mailing Address
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Address Line | 621 BROADWAY
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City | CHESTERTON
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State | IN
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Zip | 46304-2259
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Country | US
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Telephone | 219-921-5492
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Fax | 219-921-0143
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ANTHONY M MCCROVITZ
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Credential | PHD
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Telephone | 219-921-5492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | IN
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