Provider Demographics
NPI:1669613972
Name:STAR OF CA LLC
Entity type:Organization
Organization Name:STAR OF CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MOES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-644-7827
Mailing Address - Street 1:4880 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7783
Mailing Address - Country:US
Mailing Address - Phone:805-644-7827
Mailing Address - Fax:877-644-7545
Practice Address - Street 1:4880 MARKET ST
Practice Address - Street 2:SUITE 220
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7783
Practice Address - Country:US
Practice Address - Phone:805-644-7827
Practice Address - Fax:877-644-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 251S00000X
CAPSY #16222252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency