MEDICARE: STARS ACHIEVEMENT CENTER 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	NV20181196318	NV

General Provider Information

NPI Number	:	1235627126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARS ACHIEVEMENT CENTER LLC

Provider Business Mailing Address
First Line	:	1555 E FLAMINGO RD STE 125
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5259
Country	:	US
Telephone Number	:	702-826-3377
Fax Number	:	702-405-0845

Provider Business Practice Location Address
First Line	:	1555 E FLAMINGO RD STE 125
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5259
Country	:	US
Telephone Number	:	702-826-3377
Fax Number	:	702-405-0845

Authorized Official
Title or Position	:	MEMBER
Name	:	ANTHANY EARL LESSIER
Credential	:
Telephone Number	:	702-300-2990

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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