Provider Demographics
NPI:1023520798
Name:LITTLE STARS BIG GOALS, LLC
Entity type:Organization
Organization Name:LITTLE STARS BIG GOALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-883-3199
Mailing Address - Street 1:6845 SAPPHIRE POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7705
Mailing Address - Country:US
Mailing Address - Phone:303-883-3199
Mailing Address - Fax:
Practice Address - Street 1:6845 SAPPHIRE POINTE BLVD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7705
Practice Address - Country:US
Practice Address - Phone:303-883-3199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid