Provider Demographics
NPI:1427081603
Name:NORTH STAR CENTRE LLC
Entity type:Organization
Organization Name:NORTH STAR CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-361-0500
Mailing Address - Street 1:7860 GLADES RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4175
Mailing Address - Country:US
Mailing Address - Phone:561-361-0500
Mailing Address - Fax:561-479-0384
Practice Address - Street 1:7860 GLADES RD
Practice Address - Street 2:SUITE 225
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4175
Practice Address - Country:US
Practice Address - Phone:561-361-0500
Practice Address - Fax:561-479-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0202Medicare ID - Type Unspecified