Provider Demographics
NPI:1598448508
Name:STAR DEVELOPMENTAL SERVICES, INC
Entity Type:Organization
Organization Name:STAR DEVELOPMENTAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-798-6443
Mailing Address - Street 1:450 S MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6674
Mailing Address - Country:US
Mailing Address - Phone:760-798-6443
Mailing Address - Fax:
Practice Address - Street 1:450 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6674
Practice Address - Country:US
Practice Address - Phone:760-798-6443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child