MEDICARE: SUPERSTAR KIDS SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164001616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERSTAR KIDS SERVICES INC

Provider Business Mailing Address
First Line	:	4271 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6744
Country	:	US
Telephone Number	:	407-308-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	4271 NEPTUNE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6744
Country	:	US
Telephone Number	:	407-308-2666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA EUGENIA VEGA
Credential	:
Telephone Number	:	407-308-2666

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	08/27/2024

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