Provider Demographics
NPI:1508002296
Name:REAL LIFE STARS
Entity Type:Organization
Organization Name:REAL LIFE STARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSAERENGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA, MSN
Authorized Official - Phone:856-589-9050
Mailing Address - Street 1:72 E HOLLY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1197
Mailing Address - Country:US
Mailing Address - Phone:856-589-9050
Mailing Address - Fax:856-589-8255
Practice Address - Street 1:72 E HOLLY AVE STE 203
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1197
Practice Address - Country:US
Practice Address - Phone:856-589-9050
Practice Address - Fax:856-589-8255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE EDUCATIONAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty