Provider Demographics
NPI:1982892139
Name:STAR THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:STAR THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFFATATI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:909-910-4488
Mailing Address - Street 1:29582 BRIGHT SPOT RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5906
Mailing Address - Country:US
Mailing Address - Phone:909-910-4488
Mailing Address - Fax:909-440-9093
Practice Address - Street 1:414 TENNESSEE STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:RERLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5906
Practice Address - Country:US
Practice Address - Phone:909-910-4488
Practice Address - Fax:909-440-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9654261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech