MEDICARE: ALL STARS GROUP, 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	21449	NC

General Provider Information

NPI Number	:	1518193572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL STARS GROUP, LLC

Provider Business Mailing Address
First Line	:	4252 HARBOR RIDGE DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8576
Country	:	US
Telephone Number	:	336-697-5470
Fax Number	:	336-697-5470

Provider Business Practice Location Address
First Line	:	2007 YANCEYVILLE STREET
Second Line	:	ALL STARS GROUP, LLC
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5000
Country	:	US
Telephone Number	:	136-691-1779
Fax Number	:	133-669-1054

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARY J. MCDUFFIE
Credential	:	CEO
Telephone Number	:	336-691-1772

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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