Provider Demographics
NPI:1124695341
Name:EMERGING STARS FACILITATOR SERVICES, LLC
Entity type:Organization
Organization Name:EMERGING STARS FACILITATOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:N/A
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIGG
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:540-842-6164
Mailing Address - Street 1:8721 SUNNYBROOKE FARM RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22551-3450
Mailing Address - Country:US
Mailing Address - Phone:540-842-6164
Mailing Address - Fax:
Practice Address - Street 1:8721 SUNNYBROOKE FARM RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22551-3450
Practice Address - Country:US
Practice Address - Phone:540-842-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service