Provider Demographics
NPI:1912134933
Name:STAR FOUNDATION
Entity Type:Organization
Organization Name:STAR FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-857-3359
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:GEYSERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95441-0516
Mailing Address - Country:US
Mailing Address - Phone:707-857-3359
Mailing Address - Fax:
Practice Address - Street 1:2200 US HIGHWAY 441 SE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-7322
Practice Address - Country:US
Practice Address - Phone:707-857-3359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty