Provider Demographics
NPI:1003659574
Name:STARTBUPE SERVICES INC.
Entity type:Organization
Organization Name:STARTBUPE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-246-4644
Mailing Address - Street 1:3541 RANDOLPH RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5122
Mailing Address - Country:US
Mailing Address - Phone:704-246-4644
Mailing Address - Fax:704-943-3725
Practice Address - Street 1:3541 RANDOLPH RD STE 303
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5122
Practice Address - Country:US
Practice Address - Phone:704-246-4644
Practice Address - Fax:704-943-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder