Organization
CAPITAL CITY SHINING STARS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICIA STAR WILLS (OWNER)
(804) 715-2621
Entity
Organization
Contact information
Practice address
1201 COMMERCE ST, PETERSBURG, VA 23803-2904
(804) 715-2621
(804) 800-4250
Mailing address
PO BOX 1870, CHESTERFIELD, VA 23832-9108
(804) 715-2621
(804) 800-4250
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
03/26/2020
Last updated
05/29/2024
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