Provider Demographics
NPI:1477192359
Name:I'M A STAR YOUTH AND FAMILY SERVICES INC
Entity Type:Organization
Organization Name:I'M A STAR YOUTH AND FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAKINAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-888-1710
Mailing Address - Street 1:2969 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1727
Mailing Address - Country:US
Mailing Address - Phone:414-888-1710
Mailing Address - Fax:
Practice Address - Street 1:4007 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1318
Practice Address - Country:US
Practice Address - Phone:414-888-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-25
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service