Provider Demographics
NPI:1972154789
Name:MINDSTAR RESIDENTIAL COMMUNITY
Entity Type:Organization
Organization Name:MINDSTAR RESIDENTIAL COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STARLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-BIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-435-0303
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-1115
Mailing Address - Country:US
Mailing Address - Phone:414-435-0303
Mailing Address - Fax:414-206-2424
Practice Address - Street 1:5901 W BROWN DEER RD UNIT 109
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2338
Practice Address - Country:US
Practice Address - Phone:414-435-0303
Practice Address - Fax:414-206-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness