Provider Demographics
NPI:1659819308
Name:HEALTHSTAR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:HEALTHSTAR BEHAVIORAL HEALTH
Other - Org Name:HEALTHSTAR HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-633-7300
Mailing Address - Street 1:2586 7TH AVE E
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3083
Mailing Address - Country:US
Mailing Address - Phone:651-633-7300
Mailing Address - Fax:651-633-7301
Practice Address - Street 1:2586 7TH AVE E
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3083
Practice Address - Country:US
Practice Address - Phone:651-633-7300
Practice Address - Fax:651-633-7301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSTAR HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health