MEDICARE: S.T.A.R.S 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	372600000X	Adult Companion
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1215773098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S.T.A.R.S LLC

Provider Business Mailing Address
First Line	:	628 E 222ND ST STE 624
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-254-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 E 222ND ST STE 624
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2032
Country	:	US
Telephone Number	:	216-254-2615
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EBONY S WARREN
Credential	:
Telephone Number	:	216-254-2615

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	06/11/2025

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