Provider Demographics
NPI:1821235409
Name:VSTAR BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:VSTAR BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,HCM
Authorized Official - Phone:248-259-1640
Mailing Address - Street 1:2571 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1956
Mailing Address - Country:US
Mailing Address - Phone:248-259-1640
Mailing Address - Fax:248-681-3968
Practice Address - Street 1:2571 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1956
Practice Address - Country:US
Practice Address - Phone:248-259-1640
Practice Address - Fax:248-681-3968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VSTAR BEHAVIORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801069259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION92800Medicare PIN