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General NPI Number Information
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NPI Number | 1972932556
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Entity Type | Organization
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Legal Business Name | STARS THERAPUTIC SERVICES AND ADULT DAY CARE CENTER LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 4238 COMMONWEALTH ST
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City | DETROIT
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State | MI
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Zip | 48208-2911
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Country | US
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Telephone | 248-705-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 4238 COMMONWEALTH ST
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City | DETROIT
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State | MI
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Zip | 48208-2911
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Country | US
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Telephone | 248-705-0604
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. RAESHAWNDRA JETT
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Credential | MSW
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Telephone | 248-705-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 6801092554
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License Number State | MI
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