Provider Demographics
NPI:1508506841
Name:STAR LITE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:STAR LITE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASTASSJA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-404-8471
Mailing Address - Street 1:5155 S TORREY PINES DR APT 2150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0648
Mailing Address - Country:US
Mailing Address - Phone:702-945-1173
Mailing Address - Fax:
Practice Address - Street 1:5155 S TORREY PINES DR APT 2150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0648
Practice Address - Country:US
Practice Address - Phone:702-945-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness