Provider Demographics
NPI:1104319268
Name:STAR KIDS
Entity type:Organization
Organization Name:STAR KIDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-361-8578
Mailing Address - Street 1:131 S 700 E STE 101
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2483
Mailing Address - Country:US
Mailing Address - Phone:801-361-8578
Mailing Address - Fax:801-785-1012
Practice Address - Street 1:131 S 700 E STE 101
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2483
Practice Address - Country:US
Practice Address - Phone:801-361-8578
Practice Address - Fax:801-785-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1104319268Medicaid