Provider Demographics
NPI:1659012904
Name:THE STARGAZER FOUNDATION INTERNATIONAL, INC.
Entity type:Organization
Organization Name:THE STARGAZER FOUNDATION INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDER-CADYMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSS
Authorized Official - Phone:704-712-8509
Mailing Address - Street 1:1727 SARDIS RD N STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2539
Mailing Address - Country:US
Mailing Address - Phone:704-712-8509
Mailing Address - Fax:
Practice Address - Street 1:1727 SARDIS RD N STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2539
Practice Address - Country:US
Practice Address - Phone:704-712-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child