Provider Demographics
NPI:1144641002
Name:STARLIFE VENTURES, LLC
Entity type:Organization
Organization Name:STARLIFE VENTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENELICHI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:713-588-4881
Mailing Address - Street 1:10103 FONDREN RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-588-4881
Mailing Address - Fax:281-206-4664
Practice Address - Street 1:2755 TEXAS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-5114
Practice Address - Country:US
Practice Address - Phone:713-588-4881
Practice Address - Fax:281-206-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX383146OtherMEDICARE TRADITIONAL
TX383146Medicaid