MEDICARE: STARS BEHAVORIAL GROUP

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	251B00000X	Case Management Agency		CA

General Provider Information

NPI Number	:	1831233907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARS BEHAVORIAL GROUP

Provider Business Mailing Address
First Line	:	17705 S WESTERN AVE SPC 95
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3226
Country	:	US
Telephone Number	:	323-202-7056
Fax Number	:

Provider Business Practice Location Address
First Line	:	17705 S WESTERN AVE SPC 95
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90248-3226
Country	:	US
Telephone Number	:	323-202-7056
Fax Number	:

Authorized Official
Title or Position	:	PARENT PARTNER
Name	:	MR. RUSSELL BARRY ARCENEAUX IX
Credential	:
Telephone Number	:	310-868-5379

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	06/17/2008

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