Provider Demographics
NPI:1003348939
Name:START WHERE YOU STAND, INC.
Entity Type:Organization
Organization Name:START WHERE YOU STAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:AVIS
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:718-764-9742
Mailing Address - Street 1:14502 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1618
Mailing Address - Country:US
Mailing Address - Phone:718-764-9742
Mailing Address - Fax:
Practice Address - Street 1:14502 123RD AVE
Practice Address - Street 2:PRIVATE
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11436-1618
Practice Address - Country:US
Practice Address - Phone:718-764-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258533245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children