Provider Demographics
NPI:1518160654
Name:STAR COMMUNITY SERVICE, INC.
Entity Type:Organization
Organization Name:STAR COMMUNITY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPELEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-463-4000
Mailing Address - Street 1:7014 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7510
Mailing Address - Country:US
Mailing Address - Phone:323-463-4000
Mailing Address - Fax:323-463-4040
Practice Address - Street 1:7014 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7510
Practice Address - Country:US
Practice Address - Phone:323-463-4000
Practice Address - Fax:323-463-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70333FMedicaid