Provider Demographics
NPI:1811343445
Name:STARSHINE TREATMENT CENTER, INC
Entity type:Organization
Organization Name:STARSHINE TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-882-7978
Mailing Address - Street 1:460 S STODDARD AVE STE 1&3
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-2039
Mailing Address - Country:US
Mailing Address - Phone:909-882-7978
Mailing Address - Fax:909-882-1282
Practice Address - Street 1:460 S STODDARD AVE STE 1&3
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-2001
Practice Address - Country:US
Practice Address - Phone:909-882-7978
Practice Address - Fax:909-882-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360910261322D00000X
CA360911127322D00000X
CA366402532322D00000X
322D00000X
CA360910260322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children