Provider Demographics
NPI:1285772319
Name:ALL STARS GROUP LLC
Entity type:Organization
Organization Name:ALL STARS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-691-1772
Mailing Address - Street 1:2007 YANCEYVILLE ST.
Mailing Address - Street 2:STE. 209 BOX 66
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-691-1772
Mailing Address - Fax:
Practice Address - Street 1:2007 YANCEYVILLE ST
Practice Address - Street 2:STE. 209 BOX 66
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5000
Practice Address - Country:US
Practice Address - Phone:336-691-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300889BMedicaid
NC8300889FMedicaid
NC8300889GMedicaid
NC8300889HMedicaid
NC8300889Medicaid
NC8300889AMedicaid