Provider Demographics
NPI:1174818306
Name:STAR CENTER ABILITY SERVICES
Entity Type:Organization
Organization Name:STAR CENTER ABILITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:G.
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-600-5417
Mailing Address - Street 1:5416 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3610
Mailing Address - Country:US
Mailing Address - Phone:202-288-1867
Mailing Address - Fax:703-997-0425
Practice Address - Street 1:5416 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3610
Practice Address - Country:US
Practice Address - Phone:202-288-1867
Practice Address - Fax:703-997-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service