Organization
SHINING STAR LL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE WATT (CEO)
(313) 377-1849
Entity
Organization
Contact information
Practice address
533 MCDOUGALL ST, DETROIT, MI 48207-3912
(313) 567-0121
Mailing address
3430 E JEFFERSON AVE, SUITE # 401, DETROIT, MI 48207-4233
(313) 377-1849
(313) 557-2751
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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