Provider Demographics
NPI:1003150855
Name:STARLA LEE DBA AUTHENTIC TOUCH DIRECT CARE SERVICES
Entity Type:Organization
Organization Name:STARLA LEE DBA AUTHENTIC TOUCH DIRECT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-304-6708
Mailing Address - Street 1:255 S PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5834
Mailing Address - Country:US
Mailing Address - Phone:314-304-6708
Mailing Address - Fax:573-339-0878
Practice Address - Street 1:255 S PLAZA WAY
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5834
Practice Address - Country:US
Practice Address - Phone:314-304-6708
Practice Address - Fax:573-339-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-18
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21520747253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care