Provider Demographics
NPI:1457603060
Name:FIVE S.T.A.R. VETERANS CENTER, INC
Entity Type:Organization
Organization Name:FIVE S.T.A.R. VETERANS CENTER, INC
Other - Org Name:ALLIED VETERANS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:STAFF THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:904-723-5950
Mailing Address - Street 1:40 ACME ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7953
Mailing Address - Country:US
Mailing Address - Phone:904-723-5950
Mailing Address - Fax:904-723-5952
Practice Address - Street 1:40 ACME ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-723-5950
Practice Address - Fax:904-723-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TB0200X, 261QV0200X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA