Provider Demographics
NPI:1760016406
Name:S.T.A.R.-STAND TOGETHER AND RECOVER CENTERS, INC.
Entity Type:Organization
Organization Name:S.T.A.R.-STAND TOGETHER AND RECOVER CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-231-0071
Mailing Address - Street 1:3003 N CENTRAL AVE STE 675
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2915
Mailing Address - Country:US
Mailing Address - Phone:602-231-0071
Mailing Address - Fax:
Practice Address - Street 1:2502 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1412
Practice Address - Country:US
Practice Address - Phone:602-685-1295
Practice Address - Fax:602-685-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246435Medicaid
AZ980409Medicaid
AZ240781Medicaid
AS349645Medicaid