Provider Demographics
NPI:1720356314
Name:STAR CENTER
Entity Type:Organization
Organization Name:STAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIINICAL SUP.
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:313-493-4410
Mailing Address - Street 1:13575 LESURE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3131
Mailing Address - Country:US
Mailing Address - Phone:313-493-4410
Mailing Address - Fax:
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:313-493-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821426283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital