Provider Demographics
NPI:1033960646
Name:STARZ ACADEMY
Entity Type:Organization
Organization Name:STARZ ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAHO
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:507-990-8151
Mailing Address - Street 1:700 CAMBRIDGE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8368
Mailing Address - Country:US
Mailing Address - Phone:507-990-8151
Mailing Address - Fax:
Practice Address - Street 1:700 CAMBRIDGE ST APT 203
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8368
Practice Address - Country:US
Practice Address - Phone:507-990-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health