Provider Demographics
NPI:1295279115
Name:STARSHINE TREATMENT CENTER
Entity type:Organization
Organization Name:STARSHINE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-882-7978
Mailing Address - Street 1:1255 E HIGHLAND AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4653
Mailing Address - Country:US
Mailing Address - Phone:909-882-7978
Mailing Address - Fax:909-882-1282
Practice Address - Street 1:1255 E HIGHLAND AVE STE 217
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4653
Practice Address - Country:US
Practice Address - Phone:909-882-7978
Practice Address - Fax:909-882-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children