Provider Demographics
NPI:1376689273
Name:FIRSTSTARR REHABILITATION & BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:FIRSTSTARR REHABILITATION & BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:316-201-1273
Mailing Address - Street 1:4402 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3912
Mailing Address - Country:US
Mailing Address - Phone:316-201-1273
Mailing Address - Fax:
Practice Address - Street 1:4402 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3912
Practice Address - Country:US
Practice Address - Phone:316-201-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS118215Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID
KS119876Medicare ID - Type UnspecifiedPROVIDER ID