Provider Demographics
NPI:1760810428
Name:ALL STAR ACADEMY (ASA)
Entity Type:Organization
Organization Name:ALL STAR ACADEMY (ASA)
Other - Org Name:RICH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:UCHECHI
Authorized Official - Last Name:ONYENEHO
Authorized Official - Suffix:
Authorized Official - Credentials:DOSPEED
Authorized Official - Phone:952-356-2953
Mailing Address - Street 1:6000 BASS LAKE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2700
Mailing Address - Country:US
Mailing Address - Phone:952-356-2953
Mailing Address - Fax:
Practice Address - Street 1:11712 CARTIER AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3227
Practice Address - Country:US
Practice Address - Phone:952-707-9684
Practice Address - Fax:952-707-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365664251B00000X, 251S00000X, 252Y00000X
MN35664251B00000X, 251E00000X, 252Y00000X
MNS389194616120347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN625Medicaid
MN625Medicaid