Provider Demographics
NPI:1295427334
Name:STAR SOCIAL SERVICES
Entity type:Organization
Organization Name:STAR SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-279-2940
Mailing Address - Street 1:209 11TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 11TH ST NE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4534
Practice Address - Country:US
Practice Address - Phone:507-279-2940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health