Provider Demographics
NPI:1184865776
Name:STARFISH FAMILY SERVICES INC.
Entity Type:Organization
Organization Name:STARFISH FAMILY SERVICES INC.
Other - Org Name:LIFESPAN CLINICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-615-9730
Mailing Address - Street 1:30000 HIVELEY ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1089
Mailing Address - Country:US
Mailing Address - Phone:248-615-9730
Mailing Address - Fax:248-615-1260
Practice Address - Street 1:30000 HIVELEY ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1089
Practice Address - Country:US
Practice Address - Phone:248-615-9730
Practice Address - Fax:248-615-1260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARFISH FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-12
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health