Provider Demographics
NPI:1285113472
Name:NORTH STAR CENTER, LLC.
Entity type:Organization
Organization Name:NORTH STAR CENTER, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:HAWS
Authorized Official - Last Name:AHQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-229-4889
Mailing Address - Street 1:690 W. STATE STREET
Mailing Address - Street 2:PMB 34
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1972
Mailing Address - Country:US
Mailing Address - Phone:800-635-0165
Mailing Address - Fax:
Practice Address - Street 1:254 S STATE ST BLDG A
Practice Address - Street 2:
Practice Address - City:LA VERKIN
Practice Address - State:UT
Practice Address - Zip Code:84745-5633
Practice Address - Country:US
Practice Address - Phone:800-635-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH STAR CENTER, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-09
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51933261QR0401X
UT63460261QR0401X
UT39297323P00000X
3245S0500X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT51933OtherDAY TREATMENT LICENSE
UT39297OtherSTATE RTC LICENSE
UT63460OtherOUTPATIENT TREATMENT LICENSE