Provider Demographics
NPI:1538668983
Name:STARKS HOMES LLC
Entity Type:Organization
Organization Name:STARKS HOMES LLC
Other - Org Name:STARKS HOMES LLC FAYETTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:DU JUAN
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-304-6681
Mailing Address - Street 1:7325 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-2324
Mailing Address - Country:US
Mailing Address - Phone:520-304-6681
Mailing Address - Fax:
Practice Address - Street 1:7325 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-2324
Practice Address - Country:US
Practice Address - Phone:520-304-6681
Practice Address - Fax:520-437-0387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARKS HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children