Provider Demographics
NPI:1245681790
Name:STARS CDC
Entity type:Organization
Organization Name:STARS CDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEKISHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-303-9269
Mailing Address - Street 1:3540 SWENSON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-9335
Mailing Address - Country:US
Mailing Address - Phone:702-303-9269
Mailing Address - Fax:702-685-2500
Practice Address - Street 1:3540 SWENSON ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-9335
Practice Address - Country:US
Practice Address - Phone:702-303-9269
Practice Address - Fax:702-685-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041S0200X101YM0800X
NV251S00000X251S00000X
NV251B0000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health