Provider Demographics
NPI:1710266432
Name:STARFISH HERO, INC.
Entity Type:Organization
Organization Name:STARFISH HERO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:707-502-2731
Mailing Address - Street 1:600 F ST
Mailing Address - Street 2:SUITE 3-619
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6301
Mailing Address - Country:US
Mailing Address - Phone:707-845-4584
Mailing Address - Fax:707-673-5756
Practice Address - Street 1:600 F ST
Practice Address - Street 2:SUITE 3-619
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6301
Practice Address - Country:US
Practice Address - Phone:707-845-4584
Practice Address - Fax:707-673-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-09-9999103K00000X, 251C00000X, 251S00000X, 252Y00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty