Provider Demographics
NPI:1053630087
Name:NORTH STAR SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH STAR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:219-322-9904
Mailing Address - Street 1:425 JOLIET ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1765
Mailing Address - Country:US
Mailing Address - Phone:219-322-9904
Mailing Address - Fax:219-322-9956
Practice Address - Street 1:425 JOLIET ST
Practice Address - Street 2:SUITE 309
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1765
Practice Address - Country:US
Practice Address - Phone:219-322-9904
Practice Address - Fax:219-322-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty