Organization
STAR SUPPORTIVE SERVICES, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FARDOWSO ISSE (CO-OWNER)
(612) 703-5300
Entity
Organization
Contact information
Practice address
4470 W 78TH STREET CIR, BLOOMINGTON, MN 55435-5408
(612) 446-5353
Mailing address
4470 W 78TH STREET CIR, BLOOMINGTON, MN 55435-5408
(612) 446-5353
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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