Provider Demographics
NPI:1326675497
Name:CAPITAL CITY SHINING STARS
Entity Type:Organization
Organization Name:CAPITAL CITY SHINING STARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:STAR
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-715-2621
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9108
Mailing Address - Country:US
Mailing Address - Phone:804-715-2621
Mailing Address - Fax:804-800-4250
Practice Address - Street 1:8014 MIDLOTHIAN TPKE STE 308
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-715-2621
Practice Address - Fax:804-800-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health