Provider Demographics
NPI:1972932556
Name:STARS THERAPUTIC SERVICES AND ADULT DAY CARE CENTER LLC
Entity type:Organization
Organization Name:STARS THERAPUTIC SERVICES AND ADULT DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAESHAWNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:248-705-0604
Mailing Address - Street 1:4238 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2911
Mailing Address - Country:US
Mailing Address - Phone:248-705-0604
Mailing Address - Fax:
Practice Address - Street 1:4238 COMMONWEALTH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2911
Practice Address - Country:US
Practice Address - Phone:248-705-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092554251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services