Basic Information
| Provider Information | |||||||||
| NPI: | 1477034528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUNG STAR ACADEMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 ODNR MOHICAN 51 | ||||||||
| Address2: | |||||||||
| City: | PERRYSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448649407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199940300 | ||||||||
| FaxNumber: | 4199940305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1012 ODNR MOHICAN 51 | ||||||||
| Address2: | |||||||||
| City: | PERRYSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448649407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199940300 | ||||||||
| FaxNumber: | 4199940305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4199940300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 322D00000X | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.