Provider Demographics
NPI:1669221719
Name:HEALTHSTAR
Entity type:Organization
Organization Name:HEALTHSTAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILEMON MBOINI
Authorized Official - Middle Name:
Authorized Official - Last Name:NGOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-536-3360
Mailing Address - Street 1:13136 SUDWICK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8677
Mailing Address - Country:US
Mailing Address - Phone:859-536-3360
Mailing Address - Fax:
Practice Address - Street 1:13136 SUDWICK LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-8677
Practice Address - Country:US
Practice Address - Phone:859-536-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health