Provider Demographics
NPI:1659489672
Name:STAR INC
Entity Type:Organization
Organization Name:STAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:570-373-3300
Mailing Address - Street 1:600 PARK AVE
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:MARION HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:17832
Mailing Address - Country:US
Mailing Address - Phone:570-373-3300
Mailing Address - Fax:570-373-3363
Practice Address - Street 1:600 PARK AVE
Practice Address - Street 2:
Practice Address - City:MARION HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:17832
Practice Address - Country:US
Practice Address - Phone:570-373-3300
Practice Address - Fax:570-373-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWST1470367OtherBLUE SHIELD
PA1012553010001Medicaid
PA50014441OtherBLUE CROSS
PWST1470367OtherBLUE SHIELD