Provider Demographics
NPI:1568829125
Name:DAVIDSTAR ENTERPRISES
Entity Type:Organization
Organization Name:DAVIDSTAR ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOISE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:214-926-7284
Mailing Address - Street 1:4337 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3610
Mailing Address - Country:US
Mailing Address - Phone:214-560-7351
Mailing Address - Fax:
Practice Address - Street 1:4337 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3610
Practice Address - Country:US
Practice Address - Phone:214-560-7351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
32059276298320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities