Organization
MARIE STAR, INC.
Active
Other names
Stuie Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE-STUART DERAVILE (PRESIDENT)
(954) 742-6349
Entity
Organization
Contact information
Practice address
11471 NW 35TH ST, SUNRISE, FL 33323-1419
(954) 742-6349
(954) 749-8560
Mailing address
11471 NW 35TH ST, SUNRISE, FL 33323-1419
(954) 742-6349
(954) 749-8560
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
10-1215GH
FL
385H00000X
Respite Care
10-1215GH
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
686881996
—
FL
05
—
686881997
—
FL
Enumeration date
11/29/2006
Last updated
03/24/2009
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