Provider Demographics
NPI:1922136498
Name:THE FOUNDATION FOR THE S.T.A.R.S.
Entity Type:Organization
Organization Name:THE FOUNDATION FOR THE S.T.A.R.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:ANISE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-289-0157
Mailing Address - Street 1:PO BOX 530063
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0063
Mailing Address - Country:US
Mailing Address - Phone:702-289-0157
Mailing Address - Fax:702-892-0938
Practice Address - Street 1:3708 WATERHOLE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2907
Practice Address - Country:US
Practice Address - Phone:702-515-1761
Practice Address - Fax:702-515-1761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVGF-125401040-0001261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511029Medicaid
NV100511030Medicaid