Provider Demographics
NPI:1215261854
Name:STAARS - WASHINGTON
Entity type:Organization
Organization Name:STAARS - WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-365-9096
Mailing Address - Street 1:375 E 3RD ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9708
Mailing Address - Country:US
Mailing Address - Phone:919-365-9096
Mailing Address - Fax:919-365-9097
Practice Address - Street 1:411 W MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4831
Practice Address - Country:US
Practice Address - Phone:919-269-6560
Practice Address - Fax:919-269-6564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECIALIZED TREATMENT AND AFFILIATED RESOURCES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-30
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601920Medicaid