Provider Demographics
NPI:1700596608
Name:LITTLE STAR LLC
Entity Type:Organization
Organization Name:LITTLE STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER & CHIEF EXECUTIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-214-7043
Mailing Address - Street 1:1275 SILVER TIP LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9704
Mailing Address - Country:US
Mailing Address - Phone:970-214-7043
Mailing Address - Fax:
Practice Address - Street 1:1275 SILVER TIP LN
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9704
Practice Address - Country:US
Practice Address - Phone:970-214-7043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health