Provider Demographics
NPI:1689352809
Name:FUTURE STARS YOUTH SERVICES
Entity Type:Organization
Organization Name:FUTURE STARS YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECT
Authorized Official - Prefix:MS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-453-6979
Mailing Address - Street 1:PO BOX 981
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-0981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:406 MYRTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CALIMESA
Practice Address - State:CA
Practice Address - Zip Code:92320-1503
Practice Address - Country:US
Practice Address - Phone:909-810-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children