Provider Demographics
NPI:1457041782
Name:HOUSE OF STARS LLC
Entity Type:Organization
Organization Name:HOUSE OF STARS LLC
Other - Org Name:HOUSE OF STARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-499-9696
Mailing Address - Street 1:1105 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868-2851
Mailing Address - Country:US
Mailing Address - Phone:936-419-6015
Mailing Address - Fax:
Practice Address - Street 1:1105 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-2851
Practice Address - Country:US
Practice Address - Phone:936-419-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF STARS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities