Provider Demographics
NPI:1093095150
Name:STARVISTA
Entity Type:Organization
Organization Name:STARVISTA
Other - Org Name:ARCHWAY
Other - Org Type:Other Name
Authorized Official - Title/Position:HUMAN RESOUCES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-591-9623
Mailing Address - Street 1:610 ELM ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3070
Mailing Address - Country:US
Mailing Address - Phone:650-591-9623
Mailing Address - Fax:650-591-4163
Practice Address - Street 1:609 PRICE AVE STE 201
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1403
Practice Address - Country:US
Practice Address - Phone:650-591-9623
Practice Address - Fax:650-591-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health