Provider Demographics
NPI:1902557929
Name:STAROAKS BEHAVIORAL HOME
Entity Type:Organization
Organization Name:STAROAKS BEHAVIORAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:JOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-909-6953
Mailing Address - Street 1:16428 N 7TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-2603
Mailing Address - Country:US
Mailing Address - Phone:713-909-6953
Mailing Address - Fax:
Practice Address - Street 1:16428 N 7TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2603
Practice Address - Country:US
Practice Address - Phone:713-909-6953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0000Medicaid
AZBH7255Medicaid