MEDICARE: STAR ANGELS BEHAVIOR SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1063929990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR ANGELS BEHAVIOR SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	4450 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7134
Country	:	US
Telephone Number	:	786-858-6324
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA HERNANDEZ
Credential	:
Telephone Number	:	786-858-6324

Provider Enumeration Date	:	12/31/2017
Last Update Date	:	12/31/2017

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