Provider Demographics
NPI:1538244017
Name:EMPIRE STAR VENTURES LLC
Entity type:Organization
Organization Name:EMPIRE STAR VENTURES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-467-1244
Mailing Address - Street 1:12410 E SINTO AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2199
Mailing Address - Country:US
Mailing Address - Phone:509-927-7827
Mailing Address - Fax:509-928-7556
Practice Address - Street 1:12410 E SINTO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2199
Practice Address - Country:US
Practice Address - Phone:509-927-7827
Practice Address - Fax:509-928-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7123342Medicaid
WA0181044OtherLABOR & INDUSTRIES
WA7123342Medicaid