Provider Demographics
NPI:1922797141
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LEGANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-717-5049
Mailing Address - Street 1:77 E COLUMBUS AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2352
Mailing Address - Country:US
Mailing Address - Phone:602-231-0071
Mailing Address - Fax:602-231-0334
Practice Address - Street 1:3470 E ROUTE 66 STE 101
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-4059
Practice Address - Country:US
Practice Address - Phone:928-864-7199
Practice Address - Fax:928-526-1804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:S.T.A.R. - STAND TOGETHER AND RECOVER CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH8691Medicaid